LAFD Field Manual

Preface
The EMS Field Manual, LAFD Book 35, is intended to serve as a convenient reference for all Advanced Life Support (ALS) and Basic Life Support (BLS) Fire Department personnel.
The condensed information contained herein was generated from existing policies and procedures that govern LAFD EMS operations. Members are required to maintain a thorough knowledge of Department of Health Services (DHS) and LAFD policies and procedures. To maintain a high standard of expertise, as qualified health care professionals, a periodic review of these writings is recommended.
Excerpts from the (DHS) Prehospital Care Policy Manual (LAFD Book 33), DHS Medical Guidelines, LAFD Training Bulletins, Departmental Bulletins, LAFD Manual o f Operation, and EMS Updates were utilized in the compilation of this manual.
Book 35 is subject to periodic revisions as policy andlor procedures change. If field personnel identify areas that may require clarification or revision, please
contact the Quality Improvement Section at (2 13) 485-7 153.
EMS Field Manual (Book 35)
TABLE of CONTENTS
FIELD PROCEDURES / PROTOCOLS LAFD Patient Assessment Guidelines Simple Triage and Rapid Treatment (START) Acute Life Threatening Event (ALTE) Broselow Pediatric Emergency Tape 1 PEDS Color Code Patient Resolution Guide (PRG) PRG Principles Level of Consciousness Glasgow Coma Scale Revised Trauma Score Patient Refusal of Treatment andlor Transportation (AMA) I In Custody Child IElder IDependent Adult Abuse Reporting Determination of Death Patients Determined to be Dead Medical Patients in Cardiopulmonary Arrest Crime ScenesIAccidental DeathsISuspected Suicides
'
SECTION 1
1.0 1. 1 1.2 1. 2a 1.3 1. 3a 1.4 1.4a 1.4b 1.5 1. 6 1.7 1. 7a 1. 7b
1.7~
1. 7d 1. 7e 1. 8 1. 8a 1.9 1. 9a 1. 9b 1.10 1.11 1. 12 1.12a 1. 13 1. 14 1.14a 1.14b 1.14~ 1. 15
Procedures Following Pronouncement of Death Documentationfor Reports Prehospital Do-Not-Resuscitate (DNR) Orders Honoring Advance Health Care Directives (AHCD) Task Oriented EMS Standard Operating Guidelines (SOGs) [TasksIEquipment] Size-Ups SOGs for EMS Incidents (e.g., Cardiac Arrest, Trauma, Medical Complaint) Patient Transfer of Care from ALS to BLS EMT-1 Expanded Scope of Practice Poison Control System System-wide Mental Assessment Response Team (SMART) City Volunteer Programs Communications During Emergencies Miscellaneous I Highest Ranking Medical Authority Body Armor Vests Medical Waste Disposal Management of Multiple Victim Incidents I MCI Short Form
Revised: 512005
PAGE1 OF 3
EMS Field Manual (Book 35)
TABLE of CONTENTS
PATIENT TRANSPORTATION 1 DESTINATION
SECTION 2
LAFD Patient Destination Guidelines /General Principles Patients Transported by BLS Personnel Patients Transported by ALS Personnel Transport to Specialty Care Centers: SART Centers, Trauma Centers, Trauma Triage CriteriaIGuidelines, Extremis Patients Trauma Catchment / Boundary Areas Pediatric Trauma Centers
LA County Trauma Center Maps

Trauma Center Diversion / EDAP IPMC / PTC / Perinatal Burn Patients / Decompression Patient Destination Guidelines / EDAP / Patient Requests / Hospital Diversion Transporting Patients in Custody Hospital Refusal to Accept Rescue Ambulance Patients Service Area Hospitals Specialties / Exceptions Service Area Hospital Maps Los Angeles County Emergency Medical Service Receiving Facilities EMS and Battalion Offices Receiving Hospitals Sorted by EMS Battalion Captains Fire Station, Battalion, Division, EMS Battalion Chart LAFD Rescue Ambulance Locations
APPARATUS 1 EQUIPMENT
SECTION 3
Apparatus Towing Apparatus Breakdown Procedures 1 Documentation Apparatus Maintenance CAV and NAV Obtaining a Spare Gurney Multi-Casualty Medical Supply Cache Disaster Cache Box (Amy1 Nitrite I Mark I Kit) Base Hospital Hailing and Working Channel Assignments
Revised: 512005
PAGE2 OF 3
EMS Field ~ a k a (Book l 35)
TABLE of CONTENTS
RECORDS / DOCUMENTATION
SECTION 4
Records and Documentation The Journal (F-2) Hazardous Substance Exposure Report (F-3) Stores Requisition (F-80) Rescue Equipment Loan Slip (F-215M) EMS Report (F-902M) Controlled Medication Inventory (F-903) LAFD Situation Report (F-904) The Health Insurance Portability and Accountability Act (HIPAA) CAL I OSHA and FED I OSHA Notifications Communicable Disease Exposure (Contaminated Needle Puncture) Procedures I Exposure Categories
,
4. 0
1
'
Communicable Disease Exposure and Notification Report (F-420) Communicable Disease Decontamination Suspected Child AbuseINeglect Reporting Guidelines Suspected Elder and Dependent Adult Abuse Reporting Guidelines Communication Failure Protocol Mnemonics Abbreviations Bibliography Record of Revisions
Revised: 512005
PAGE3 OF 3
Section 1: Field Procedures 1 Protocols
LAFD PATIENT ASSESSMENT GUIDELINES
/ SKIN SIGNS
SCENE Safety (BSI PrccautionsJPPE) + Environment Mechanism of Injury + Number of Patients IMPRESSION
^ ^
^
AIRWAY BREATHING (AssistfOxygen) CIRCULATION (RadialICarotid) + Pulses + Capillary Refill + Control Severe Bleeding (PRN)
+ Color + Temperature + Moisture
CHIEF COMPLAINT (SignsISymptoms)
^ GENERAL
+ +
+ What you see!
Objective Observation Subjective Findings (What they say!)
FIRST- PERFORM FOCUSED BODY CHECK (Determinedby LOG, Chief Complaint, and History)
4 4 4
P U LS E (Rate, Rhythm, Quality) RESPIRATION (Rate, Rhythm, TV) B P (Systolic/Diastolic) [Orthostatic's PRN]
Glasgow Coma Scale (GCS) ASSESS BILATERAL BREATH SOUNDS for patients with chest injuries, difficulty breathing, and I or signs of shock
j
LO 0 K F E EL
4
COMPLETE BODY CHECK

for Tissue Damage, Scars, Deformities, Abnormal Behavior I Motion, Fluids for Tenderness, Instability, Crepitus
4 4 4
HEAD NECK CHEST
BREATHSOUNDS ABDOMENIPELVIS EXTREMITIES (UpperILower)
4 NEUROLOGICAL
4 4
4 BACK
4 MEDICAL TAGS,
TRACKS, TRAUMA
DEFORMITY CONTUSION ABRASION PUNCTURE1 PENETRATING
BURNS TENDERNESS LACERATIONS SWELLING
PULSES MOTOR SENSORY
Revised: 1212001
Section I: Field Procedures 1 Protocols
LAFD PATIENT ASSESSMENT GUIDELINES
FOCUSED HISTORY
0 Onset P Provokes
Q Quality
S SignsISymptoms
Alcohol1Apneal Anaphylaxis1
T Trauma 1 Infection
A Allergies E EpilepsyIEnvironment
/
Insulin StrokeIShockl Seizure
M Medications P Past History L Last AteIDrank E Events Preceding

RegionIRadiationl Recurrence
S Severity
0 Overdose U Uremialunderdose
T Time
C Cardiovascular
AIRWAY (OIP, Mask) BREATHING (Position IBVM 102)
SPINAL PRECAUTION GLUCOSE OB ASSISTANCE BANDAGING 1 SPLINTING
Position Patient) CIRCULATION (Direct Pressure I

CONTROL BLEEDING
ONGOING ASSESSMENT
REPEAT.
Initial and Focused exam: Priority patients every 5 minutes Stable patients every 15 minutes
Motor Response Verbal Response
1
Have a Plan! Route! Code 3? Treatment En Route?
REVISED TRAUMA SCORE (RTS) ,. ... . (Uoded Values) SBP + RR + GCS
Revised: 1212001
SIMPLE TRIAGE and RAPID TREATMENT

-\
START
ASSESS
RespiratiodRate
b
ABSENT
REPOSITION
Airway and
REASSESS
Respiration
ASSESS
Circulation
0
< 2 sec. /
RADIAL PULSE
PRESENT
ASSESS
Mental Status
Simple Triage and Rapid Treatment

Revised: 1212001
ACUTE LIFE-THREATENING EVENT (ALTE)

An ALTE may occur during sleep, wakefulness, or feeding in the pediatric patient. It is described as an episode that is frightening to the observer and characterized by a COMBINATION of:
* * *
Transient Apnea Color Change Marked Muscle Tone Changes Choking 1 Gagging
Upon EMS arrival this pediatric patient may appear completely normal and asymptomatic. However, a complete and accurate history of the event is critical in determining ALTE.
Base Hospital contact is required. If the circumstances surrounding the incident are vaguelunclear it is the base station MICNs responsibility to determine the appropriate destination for the patient.
ALTE may be a symptom of many specific disorders including, but not limited to, gastrointestinal reflux, infection, seizures, airway abnormality, hypoglycemia, metabolic problems, or impaired regulation of breathing during sleep and feeding. ALTE was previously called a "Near-miss SIDS."
THE MOST IMPORTANT DIAGNOSTIC STEP IS TO OBTAIN A CAREFUL HISTORY OF THE CURRENT COMPLAINT FROM THE PERSON WHO WITNESSED THE EVENT.
The evaluation and history taking for ALTE patientsconsists of:
* * * * * * * * * *
Color (red, pale, cyanotic) Respiratory Effort (apnea, obstruction, irregular) Sleep Status (awake, asleep) PositionMotor (prone, supine, uprightllimpness) Breathing PatternINoises (choking, stridor) Eye Movement (closed, startled, rolled, fluttering) Relationship to Feeding Fluid in the Mouth Duration Need for Intervention
* Age 1-3 years: Base Contact andor Transport is required.

Age 0- 12 months: Transport regardless of chief complaint andor mechanism of injury.
'
ALTE patients age 12 months and under: BASE CONTACTm g .J TRANSPORT to a PCCC is required.
Revised: 1212001
PAGE 1 OF 2
BROSELOW PEDIATRIC EMERGENCY TAPE

The Broselow Pediatric Emergency Tape is a mandatory piece of equipment carried on all ALS units in Los Angeles County. The Broselow Tape is used to estimate weight, drug dosages, and correct size of equipment for pediatric patients up to 74 pounds [34 kg]. It is mandatory to use the Broselow Tape on all ALS pediatric patients. [Refer to "EMS Update 2001 '7 After determining the correct color code, document the three-digit color code in the Peds Color Code Box, Incident Info Section of the EMS Report [F-902Ml. For billing purposes, convert the kilograms to pounds and document in the weight box. Use only the color code when reporting to the Base Hospital. The color coding system is designed to reduce calculation errors associated with medication administration. If the infant's size falls into the "gray" area [first section of the tape: 3 kg., 4 kg., or 5 kg.] it is necessary to report the specific weight and color to the Base Hospital. For all other color coded sections it is only required to report the color code.
GY3 YEL
GY4 WHT
GY5 BLU
PNK ORG
RED GUN
PUR
-
Placement of the Broselow Tape for measuring from the standing or supine position is as follows : Place the RED end of the tape for.. ....
STAND IN G : To the heel of the foot and measure to the top of the head. SUPINE:
To the top of the head and measure to the heel of the foot [while extending the leg].
Note: The pediatric drug dosages are only to be taken from the "Color Code Drug Doses LA County Kids" (laminated cards) that are carried on each ALS unit. THE BROSELOW TAPE IS ONLY TO BE USED TO DETERMINE THE COLOR CODE.
Revised: 512005
PAGE 2 OF 2
LEVEL of CONSCIOUSNESS
EMS personnel shall perform a patient assessment to determine orientation and level of consciousness an each patient they encounter. This assessment should determine patient's state of awareness and orientation to time, place, person, or purpose [A & 0 X 3 per LA County Medical Guidelines]. Inappropriate aggressiveness or hostility should alert members to the possibility that the patient's thinking process may be impaired. EMT-Is shall access an EMT-P resource any time a patient is unable to reasonably answer one or more of the following questions:
+ Name
+ Day of the week I year I time of day
+ Where helshe lives I where they are now
GLASGOW COMA SCALE (GCS)
ADULT ( % 14 year)
Spontaneous To Voice To Pain None Obedient Purposeful Withdrawal Flexion Extension None Oriented Confusion Inappropriate Incomprehensible None
21HLD (12 months to 14 years)

Spontaneous To Voice To Pain None Obedient Localizes Withdrawal Flexion Extension None Oriented Confusion Inappropriate Incomprehensible None
5 4
I 1
3 2 1
In addition to the numerical Glasgow Coma Scale (GCS), document a brief descriptive assessment on the EMS Report Form (F-902M) . The GCS is required to assess neurological status on all patients greater than twelve (12) months of age. This includes patients who do not have an altered level of consciousness. After consultation with the primary care giver, the patient examiner shall estimate the appropriateness of the response for the younger child that is not able to communicate (motor response-obedient and verbal response-oriented).
Revised: 512005
PAGE1 OF 2
REVISED TRAUMA SCORE
(RTS)
The Revised Trauma Score (RTS) is a physiological scoring system to determine the survival probability of trauma patients. If the patient (age one year and above) meets trauma center criteria and is transported to a Trauma Center or PTC the RTS shall be completed and documented on the EMS Report Form (F-902M).
THREE assessment elements comprise the RTS:
+ SYSTOLIC BLOOD PRESSURE (SBP) + RESPIRATORY RATE (RR) + GLASGOW COMA SCALE (GCS)
ASSESSMENT ELEMENT IS GIVEN A "CODED VALUE" (CV). THE "CVS" ARE THEN TOTALED TO GIVE THE RTS ("0-12").
The "coded value" (sum) of the: SBP + RR + GCS =
RTS
CALCULATING
RTS
(2+2+3)
N x : If unable to auscultate or palpate a blood pressure due to hypo-perfusion7enter a value of "1 ." (The lower the score the more critical the patient.) Document the rational for a palpated blood pressure in the F-902M Comments section . The RTS is heavily weighted toward the GCS to compensate for major head injury without multi-system trauma or major physiological changes.
Revised: 512005
PATIENT REFUSAL of TREATMENT 1 TRANSPORTATION
EMT-Is may allow a patient to refuse treatment I transport if g l J the following conditions are met: The patient's condition does not meet any criteria on the Patient Resolution Guide (PRG).
The patient does not meet altered level of consciousness criteria as described in DHS, Ref. No. 809. The patient understands the severity of their condition and has a plan for follow-up medical care. Patient understands and signs the F-902M in the space provided. Additionally, the patient receives the Patient After Care Instruction form [back of the F-902M Pink copy].
Note:
* *
IF THE PATIENT DOES NOT MEET THE ABOVE CRITERIA, AN ALS RESOURCE SHALL BE REQUESTED TO DOCUMENT THE PATIENT'S REFUSAL (AMA). A PARAMEDIC WORKING ON A BLS RESOURCE MAY NOT HANDLE AMA'S IN LIEU OF AN ALS RESOURCE.
A BLS resource shall request a Paramedic RA. EMT RA shall request the closest ALS resource e.g., Paramedic Engine, ALS RA. The ALS resource shall make base hospital contact while with the patient. Advise base hospital of all circumstances, patient's condition, and the reason for refusal.
Have the patient or legal guardian sign the AMA form [back of the F-902M White copy]. If the patient refuses to sign the AMA form, this shall be documented in the Comments section of the F-902M. Refer to Book 35, Section 2.0: "Patient Destination Guidelines". An EMS Battalion Captain shall be requested to respond to the incident if the Paramedics are uncomfortable with any aspect of the AMA. (Dept. Bulletin No. 01-10)
. ' \
PATIENTS IN CUSTODY
.
Patients under the care or in custody of law enforcement often pose a challenge for pre-hospital care providers. These patients represent a very high degree of medical-legal risk. Patient care, documentation, and transportation must be in accordance with existing policies and procedures. Members are required to conduct a complete Initial and Focused assessment which includes vital signs, pertinent negative findings and a statement on the F-902M (EMS Report) which outlines the chief complaint and/or the reason for the 9- 1- 1 call. Members must remember that the history on these patients should be suspect due to the possibility of the patient being under the influence of illicit drugs, may not have access to their prescription medications, or may have sustained trauma with no obvious signs or symptoms; and patient care should not be based solely upon the history obtained. All members are reminded that patients in custody may refuse care BUT cannot refuse transportation to an emergency department for evaluation. Patients who refuse treatmentltransport and whose chief complaints meet the PRO Section I and I1 or Reference 808 criteria require transport and/or base hospital contact.
Transporting Restrained Patient's (Reference No. 838) Restraint equipment (handcuffs, plastic ties, or "hobble" restraints) applied by law enforcement officer: Must provide sufficient slack to allow patient to take full tidal volume breaths. Requires the officers continued presence (the officer shall accompany the patient in the ambulance) Must not compromise the patients respiratory/circulatory systems. (Transport patient in supine position.) Must not cause vascular, neurological, or respiratory compromise.
Patient's restrained extremities shall be evaluated for pulse quality, capillary refill, color and temperature, nerve and motor function immediately following application and every 15 minutes thereafter. Documentation is necessary to justify actions done or not done if unable to perform the above. Restraints may be attached to the frame of the gurney but not to the movable side rails.
Revised: 512005
PAGE 1 OF 1
CHILD / ELDER / DEPENDENT ADULT ABUSE
EMT-Is and EMT-Ps are required to report all cases of suspected abuse and/or neglect as soon as possible.
,,
ABUSE
punishment, willful cruelty, unjustifiable punishment, or sexual assault.
1.
Failure of any person having the care and/ or custody of a child, elder, or dependent NEGLECT adult to exercise that degree of care which a reasonable person in a like position would exercise. CHILD
ELDER
Request OCD to notify and have the appropriate law enforcement agency report to the incident location or hospital if the patient is to be transported. The law enforcement agency will assign an investigator. If the patient does not require immediate transport wait for the responding law enforcement agency unless a responsible adult (other than the abuser) remains on scene. forward the completed Department of Social Services Report to the appropriate EMS Battalion Captain within 36 hours. Make a Journal (F-2) entry, that shows the report was completed and forwarded.
\
2-
Any person under 18 years old. Any person 65 years old or older.
1 I
,
3. The member in charge of patient care shall
Any person between the ages of 18 and 64 years that cannot fully care for DEPENDENT himherself due to physical and/or ADULT mental limitations.
4.
N B : While on scene obtain names, addresses, and telephone numbers of witnesses, victims, siblings, parents, and law enforcement / investigating officer (s) involved with the incident,
Field members may obtain copies of the Social Services (8572) form "Suspected ChildAbuse Report" from the concerned EMS Battalion Captain or find the form listed in the Prehospital Care Policy Manual, Book 33, Reference No. 822.2. The Social Services form "SuspectedDependent Adult/Elder Abuse may also be found in Book 33, Reference No. 829.2.
"
Revised: 712003
DETERMINATION OF DEATH
\
A patient may be determined dead if in addition to the absence of respiration, cardiac activity, and neurological reflexes, one or more of the following conditions exists (DHS, Reference # 814):
+ + + 4 + + + +
Decapitation. Massive crush injury. Penetrating or blunt injury with evisceration of the heart, lung, or brain. Decomposition. Incineration. Extrication time greater than 15 minutes, with no resuscitative measures performed prior to extrication. Pulseless, non-breathing victims of a multiple victim incident where insufficient medical resources precluded initiating resuscitative measures. Drowning victims, when it is reasonably determined that submersion has been greater than one hour. Rigor mortis requires assessment (as described in Section 1.7a ).
Patients Determined to be Dead

If the initial assessment reveals rigor mortis andor post-mortem lividity &, EMS personnel shall perform the following assessments: (NN: Assessment steps may be performed concurrently.)
RESPIRATORY
* Assuring that the patient has an open airway * Look, listen, and feel for respiration
(This includes auscultation of the lungs for a minimum of 30 seconds)
CARDIAC
* Auscultation of the apical pulse for a minimum of 60 seconds * Adults and children: Palpation of the carotid pulse for a minimum of 60 seconds
Infants: Palpation of the brachial pulse for a minimum of 60 seconds
NEUROLOGICAL
* Assess pupil response with a penlight or flashlight

* Check for a response to painful stimuli
Resuscitative measures shall not be initiated on patients who have been determined dead (according to this policy) or on patients who meet DHS, ~ e f No. . 815, "HonoringPrehospital DNR Orders"
Medical Patients in Cardiopulmonary Arrest

Initiate immediate resuscitation and ALS intervention for patients who do not meet conditions described in Section 1.7. In general, these patients shall be:
,
* Treated in the field long enough for possible resuscitation to occur.

in refractory ventricular fibrillation or ventricular tachycardia.
Revised: 1212001
PAGE1 OF 2
* Rapidly transported if an adequate airway or venous access cannot be established. * Treated and transported if the patient is: A suspected drug overdose, hypothermic,
Crime Scenes I Accidental Deaths I Suspected Suicides
+ Responsibility for patient health care management rests with the most medically qualified
person on scene.
+ Authority for crime scene management shall be vested in law enforcement. It may be necessary
to ask law enforcement officers for assistance to create a "safe path" into the scene to access the patient, while minimizing scene contamination.
+ If law enforcement is not on scene, prehospital care personnel shall attempt to create a "safe path"
and secure the scene until their arrival.
Procedures Following Determination of Death
All therapeutic modalities initiated during the resuscitation must be left in place. (This includes ET 1 ETC tubes, IV catheters, EKG electrodes, and oral 1 nasal pharayngeal airways.) The deceased shall not be moved without the Coroner's authorization.
N B : It may be necessary to move the deceased if the scene is unsafe or if the deceased is creating a hazard. In such emergent situations, field personnel may relocate the deceased to a safer location or transport to the most accessible receiving facility.
', 1
-
Documentation for Reports
+ The criteria used to determine death.
(Listed in Section 1.7a.)
The condition of the patient and what, if any, resuscitation interventions were initiated. If movement of the deceased was authorized by the Coroner document: The case number and the representative who authorized the movement.
+ If the deceased was moved, document the location and the reason why.
Revised: 1212001
PREHOSPITAL DO-NOT-RESUSCITATE (DNR) ORDERS

'
-\
, FOR PULSELESS AND APNEIC
PATIENTS WITH VALID DNR ORDERS: EMT-Is shall a begin CPR or attach defibrillator EMT-Ps shall a begin CPR or attempt ALS procedures (Combi-tube, ET, cardiotonic drugs, etc.)
1.
2.
Identification by witness who can absolutely identify patient/ID bands; and Written physicians order in patient's chart, such as:
1. 2.
Identification by witness who can absolutely identify patient1ID bands; and Presence of an original (or copy):

No Code
NoCPR Do-Not-Resuscitate; or
Los Angeles County Do-Not-Resuscitate (DNR) Form (Ref No. 815.1) State Prehospital Do-Not-Resuscitate (DNR) Form (Ref No. 815.2)
3. Verbal physician's order (in person) which must be followed immediately in writing.
1. Check the "DNR" box on the F-902M, (EMS Report form).

2.
1. 2.
Check the "DNR" box on the F-902M (EMS Report form). Briefly describe in the Comments section:
Briefly describe in the Comments section:

Any care given The physician's name and telephone number The date the DNR order was originally signed
Any care given The physician's name and telephone number The date the DNR order was originally signed
.
3.
3.
Attach a photocopy of the facility's DNR order to the F-902M (White copy).
If available, attach page 2 of the DNR form (provider agency copy) to the F-902M (White copy) prior to forwarding. If the provider agency copy or photocopy is not available, record all DNR information on the F-902M. Do a take the patient's copy if it is the only copy on scene.
In the prehospital setting, a Living Will or Durable Power of Attorney are non-acceptable DNR forms.
Revised: 1212001
PAGE1 OF 2
PREHOSPITAL DO-NOT-RESUSCITATE (DNR) ORD'ERS
Resuscitation shall begin immediately and paramedics shall contact the base hospital for further direction if there is any objection or disagreement by family members or caretakers about withholding resuscitation; or if prehospital personnel have any reservations about the validity of the DNR order.
For patients who are a pulseless and apneic with valid DNR orders, EMT-Is and EMT-Ps shall provide for their comfort, safety, and dignity by using the following appropriate supportive measures:
EMT-IS:
+
Maintain Airway (Oropharyngeal 1Nasopharyngeal Airways) and Suctioning Administer Oxygen Control External Hemorrhage Apply Dressings, Bandages, and Slings Immobilize Skeletal Injuries Position of Comfort (In addition to the above)
+ +
+ +
EMT- Ps :
+
+
Visualize airwaylremove foreign bodies by means of a laryngoscope and Magill forceps Contact base hospital if IV access andlor pain medication is necessary
In the event of deterioration of the patient's vital signs, level of consciousness, or of cardiopulmonary arrest, continue transporting to the designated receiving facility (even though it may not be the most accessible). Transport to the patient's requested treating facility. If the patient's caretaker is unable to provide care, advise transport. (A private ambulance may be suggested.) Generally, emergency transport is not necessary but left to the discretion of EMS personnel. (Emergency transportation may be necessary for such cases as hemorrhage, unmanaged airway, severe pain, etc.). (DHS, Reference # 8 15)
Revised: 121200 1
PAGE2 OF 2
ADVANCED HEALTH CARE DIRECTIVES (AHCD)
California law on AHCDs recognizes that adults have the fundamental right to control the decisions relating to their own health care, including the decision to have life-sustaining treatment withheld or withdrawn. The AHCD enables patients (over the age of 18) who are unable to speak for themselves (e.g., coma, Alzheimer's, etc) to provide their health care instructions. A VALID AHCD MUST MEET THE FOLLOWING REQUIREMENTS:
4 Patient is unable to make their own life decisions

d d d d d
Power-of-Attorney Health Care Agent is designated with effective DATE End of Life Decision box is designated (checked) Two witness signatures and DATED, or Notary Public Signed by a Patient Advocate or Ombudsman if the patient is in a skilled nursing facility
Note: An AHCH has reciprocity between states and must be honored if all the above are completed.
If the patient's caretaker is unable to provide care, advise transport. (A private ambulance may be suggested.) Generally, emergency transport is not necessary but left to the discretion of EMS personnel. Emergency transportation may be necessary for such cases as hemorrhage, unmanaged airway, severe pain, etc. (DHS, Reference # 818) GUIDELINES FOR PREHOSPITAL CARE PERSONNEL: Provide the level of care according to the patient's wishes and/or medical condition when dealing with Advanced Health Care Directives and bbDo-Not-Resuscitate (DNR)" orders.
_
AJ-S and BLS shall provide for the patient's comfort, safety, and dignity by using (he following appropriate measures:
ASSIST VENTILATIONS (via a bag-valve-mask device) CHEST COMPRESSIONS AUTOMATED EXTERNAL DEFIBRILLATOR (AED) (only ifBLS is on scene prior to the arrival of ALS)
ADVANCE AIRWAY MANAGEMENT + DEFIBRILLATION CARDIOVERSION
CARDIAC DRUGS: Adenosine Epinephrine Atropine Lidocaine
pulmonary resuscitation, defibrillation, drug therapy, and other life saving measures.
Dopamine
AIRWAY MANEUVERS (including removal offoreign body) SUCTIONING OXYGEN ADMINISTRATION HEMORRHAGE CONTROL
Revised: 812003
PAGE1 OF 1
HYDRATION 1 DIURESIS GLUCOSE ADMINISTRATION
+
+
+ +
PAIN CONTROL (i. e., morphine)
TASK ORIENTED EMS STANDARD OPERATING GUIDELINES

tf
EMS Standard Operating Guidelines (SOGs)are intended as guidelines to establish pre-determined tasks for each member of the company. Company Commanders shall assign taskslresponsibilities based upon the expertise of each team member. Additionally, the tasks designated for each of the following four positions are not intended to supersede any pre-existing duties assigned to the member. The medical condition of the patient determines the work flow and sequencing of tasks.
A-B
Person
The "A-B" (Airway-Breathing)person who assesses the airway; applies oxygen; determines the respiratory rateltidal volume; and any signs of distress while checking breath sounds. In cases of cardiac or respiratory arrest, the "A-B" person inserts the airway and performs bag-valve-mask (BVM) ventilation. The "C" (Circulation) person is responsible for preserving the circulation by stopping any overt bleeding, and obtains the pulselrate and blood pressure. For pulseless patients: applies the automated external defibrillator (AED); attempts defibrillation; and provides chest compressions for CPR, as necessary. The "D" (Disability) person is responsible for preventing further patient disability by assessing the current degree of disability and applies splintslspinal immobilization as necessary. In cardiac arrest cases: assists with equipment needs (such as oxygen bottles, backboard, and gurney); assists the paramedics with IV line preparation and equipment needs. In many situations, the fourth member of the company is unavailable since the Engineer has apparatus responsibilities. However, the Engineer may assist the rescue as described above and may be able to assist when the patient is outside of a structure. The "E" (Executive) person ensures that all of the other team members are properly performing their tasks. In cardiac arrest cases, the "E"person assists the "C" person set up the automated external defibrillator (AED) to ensure rapid application. The "E" person assesses the scene for safety, initiates the F-902M, keeps records of interventions and their delivery times, interacts with family members to obtainlrecord patient information which includes: medical history, allergies, a current medications list, current address (include ZIP code), and (if available) Medi-Cal number. Even when dispatched simultaneously (with an ALS unit), fire company members shall perform the above tasks (including defibrillation) as a team.
c
Person
D
Person
E
Person
Suggested personnel for each EMS team assignment and equipment to be carried to the patient:
A-B
FF or FF/PM Firefighter Engineer or A 0 Captain

PAGE 1 OF 4
Oxygen, BVM, and airway managementJsuction bag AED and medical box Flashlight, splints, backboard, gurney as needed F-902M and Radio
c
\
. ./
D E
Revised: 1212001
Note: ALL personnel shall exercise good judgment and follow Department policy regarding equipment and medical supplies carried to the patient(s) on initial approach.
Medicallstarter Box Oxygen (with respiratory supplies) Defibrillator
Medicallstarter Box Oxygen (with respiratory supplies) Trauma Box
Medicallstarter Box Oxygen (with respiratory supplies) Disposable OB Kit
MedicallTrauma Box Oxygen (with respiratory supplies) Defibrillator
Additionally, for incidents occurring above the first floor ,the gurney shall be brought in.
SIZE-UPS
Size-ups shall be given to additional resources responding with the fire company. In particular, a size-up for an EMS incident shall be provided under the following conditions:
+
+
Requests for an ALS unit when a BLS unit is dispatched for an "A" or "B" category call. Additional resources requested beyond the original dispatch.
When multiple resources are dispatched to a single incident, the first unit on scene shall provide a brief size-up and may cancel or down grade, to non-emergency, the additional resources when appropriate. It is not uncommon for a BLS Engine, a Paramedic Assessment Engine, and a Paramedic Rescue to be dispatched on a single incident. Exercise good judgment in terms of additional resources to proceed through, and if so, whether emergency or non-emergency. In addition, if the patient is stable but still requires transport or an ALS resource for documentation only, consideration shall be given to have that resource proceed through nun-emergency. The "EMS size-up" (given on TAC 10) shall include the following information and be very brief (vital signs normally are not included):
Revised: 121200 1
PAGE2 OF 4
To further describe the tasks to be performed by each team member, the following examples of EMS incidents (with the SOGs for fire personnel) are listed:
TEAM
COMPANY PERSONNEL
TASKS
FF or FFPM
Assess airway; suction as needed; basicladvanced airway, BVM; observe for chest rise and gastric distention. Announce 10-second time intervals when the paramedic performs intubation. Utilize the automated external defibrillator (AED) to analyze EKG rhythm; defibrillate as needed; chest compressions of CPR; carotid pulse checks; if applicable, obtain the AED Code Summary and initiate the F-901 (Cardiac Arrest Outcome Data Sheet). Anticipate and provide necessary equipment; direct paramedics t o the patient; assist with IV line preparation; gather and properly dispose of medical waste. Person with Supervise team; assess scene safety; assist bbC" AED rapid application; interact with familyhystanders. Initiate F-902M; record patient assessment data (and times); interventions (and times); patient's medical history and list of medications, and (if available) Medi-Cal number, address (include ZIP code). Give a brief size-up to the paramedics.
TASKS
Firefighter
Engineer or A0
Captain
TEAM
COMPANY PERSONNEL
A-B
Administer Oxygen at 15Llmin.; auscultate lungs to determine equal breath sounds; assess: airway, rate of respirations, and tidal volume. As needed: suction, BVM, provide and maintain cervical support. Check for: pulse and rate; blood pressure; perform total body check; control bleeding. Assess: LOC, skin signsleyes. Determine GCS I RTS, chief complaint, and obtain medical history. Apply dressings, bandages, splints, and spinal immobilization as needed. Anticipate and obtain necessary equipment. Provide lighting. Direct paramedics to the patient; obtain gurney; assist with IV line preparation; gather and properly dispose of medical waste.
-
Firelighter
Engineer or A0
Captain
Supervise team; assess scene safety; determine the need for additional resources; interact with farnilyhystanders; initiate F-902M. Record patient assessment data (and times); record interventions (and times); obtain patient's medical history and current medications list, and (if available) Medi-Cal number, address (include ZIP code). Give a brief size-up to the paramedics.
Revised: 912003
MEDICAL COMPLAINT
CHEST PAIN
SEIZURE
DIABETIC PATIENT
TEAM
COMPANY PERSONNEL
FIRE
BLS & ALS
TASKS
A-B
ALS RA PM
Assess: airway, respiratory rateltidal volume. Auscultate lungs for breath sounds. As needed: administer Oxygen, suction, BVM. Assess: pulselrate, blood pressure, skin signs, eyes. Complete total body check. Determine LOCIGCS. Obtain chief complaint and medical history. Anticipate and obtain necessary equipment (gurney). Direct paramedics to the patient. Assist with IV line preparation. Gather and properly dispose of medical waste. Supervise team. Assess scene safety and additional resource needs. Interact with familyhystanders. Obtain the patient's correct address (include ZIP code), Medi-Cal number (if available), medical history, allergies and list of current medications. Initiate the F-902M, record patient assessment data (and times), interventions (and times). Give a brief size-up to the paramedics.
c
Engineer
BLS RA FF
or
A0
BLS RA FF
Captain
ALS RA PM
Revised: 1212001
Section 1:
Field Procedures 1 Protocols
PATIENT TRANSFER OF CARE FROM ALS TO BLS UNIT
The decision to transport a patient is governed by: The patient's medical condition The patient's chosen receiving facility Medical judgment of the on-scene medical authority
DHS policies and guidelines LAFD policies
If the patient does not require ALS level care, the patient may be transported by a BLS ambulance. Members shall include the following steps when transferring care from an ALS unit to a BLS unit: Base hospital approval is required if the patient meets base hospital contact criteria. Obtain agreement from the BLS receiving team to accept responsibility for the patient. Advise the BLS receiving team of the patient's condition, history, physical assessment, and all treatment rendered. The ALS unit initiates the F-902M EMS Report and completes the appropriate sections ensuring that the unit and team member numbers are clear and legible.
The Green copy of the F-902M report shall be retained by the ALS unit. All other F-902M report copies are given to and completed by the BLS [transporting] unit.
Revised: 1212001
PAGE 1 OF 1
EMT-1 EXPANDED SCOPE OF PRACTICE

County of Los Angeles EMS Agency (Ref. No. 802) EMT-I Expanded Scope - ofpractice (Treatment Protocols, Interfacility, andlor 9- 1- 1responses)
Prior to arrival of paramedics or transport: Place patient in position of comfort
Approved by transferring physician: Nasogastric (NG) tubes
High flow 02 Monitor vital signs Shock position PRN
Gastrostomy tubes Heparin locks Foley catheters Tracheostomy tubes Indwelling vascular access lines CVP monitoring devices Arterial lines including Swan Ganz catheters
Monitor, maintain, and adjust preset rate: + Glucose solutions
+ +
Isotonic salt solutions (e.g., Normal Saline or Ringer's Lactate)

(May turn off i f infiltrated)
Adjusted to TKO rate by hospital personnel:
If available and indicated, assist patient or allow self-administration if criteria is met:
Folic acid-max
1 mg/1000 ml 1 vial/1000 ml
Sublingual nitroglycerine aerosol or tablets
Multi-vitamins-ma.
Systolic BP greater than 100
Thiaminemax 100 mg/1000 ml
Bronchodilator inhaler or nebulizer
Require infusion pump at preset rate: KCL-max 20 mEq11000 ml
* Alert enough to use inhaler
+ + +
Epinephrine device (Auto-Injector)
Total Parenteral Nutrition Chemotheraputic agents with required precautions (Spill Kit)
* Signs and symptoms of severe allergic

reaction (Respiratory distress or hypoperfusion)
May be implanted or external: Insulin
+ If assistance is given, EMT-Is shall not cancel EMT-P response. + An ALS resource shall be requested if one has not been dispatched. + In life-threatening situations, consider
BLS transport if ALS arrival is longer than BLS transport time.
Demerol (Meperidine) Morphine
revised: 121200 1
PAGE1 OF 1
POISON CONTROL CENTER

The California Poison Control Center is a facility that provides information and advice regarding the management of individuals who have or may have ingested or otherwise been exposed to poisonous or possibly toxic substances.
ACCESSING A POISON CONTROL CENTER:
9-1-1 PROVIDERS
(800) 404- 4646

(800) 41 1- 8080 (800) 876- 4766
Health Professionals Public Hotline
SYSTEM-WIDE MENTAL ASSESSMENT RESPONSE TEAM
In 1993 the Department of Health Services in cooperation with the Los Angeles Police Department committed resources to staff a system-wide mental assessment response team (SMART) in the City. SMART is designed to provide a cooperative, compassionate mental health 1 law enforcement response team to assist affected citizens in accessing available mental health services. The team is able to assist in providing quick resolutions without unnecessary incarceration or hospitalization. SMART consists of nine teams including a supervisory team. Each team will be composed of one police officer and one Department of Mental Health clinician. The SMART goals are to:
* Prevent unnecessary incarceration andlor hospitalization of mentally ill individuals.
* Provide alternate care in the least restrictive environment through a coordinated and
comprehensive system-wide approach.
* Prevent the duplication of mental health services. * Allow police patrol units to return to service sooner.
SMART
HOURS of OPERATION
Telephone: (213) 485-4188
1
1
Day Watch:
1
1
0700 hours to 1530 hours 1530 hours to 2400 hours
1
1
PM Watch:
SMART personnel shall request an ambulance to transport a person when: * The person is in need of immediate medical attention requiring transportation by EMS personnel
* The person is extremely violent and requires restraint to the extent that they must be transported
in a recumbent position.
* The violent person is injured or physically ill and is in need of immediate medical attention.
N B : When a mentally disordered andor violent person is transported by ambulance, at least one police officer shall accompany the patient.
Revised: 121200 1 PAGE1 OF 1

b
CITY VOLUNTEER PROGRAMS

CRISIS RESPONSE TEAM [CRT]
/
On November 25, 1998, under the direction of the Mayor's Office, Volunteer Bureau, Crisis Response Teams began City-wide operation. Crisis Response Team (CRT) members are trained civilian volunteers who respond, on request, to FirelPolice emergencies to perform immediate andlor short term on-scene intervention to victims, families, witnesses, and survivors of traumatic events.
These teams do not perform counseling functions and will not function in the capacity of Department Critical Incident Stress Debriefing Teams for Firefighters and/or Police Officers.
CRT members may be requested for any incident which, in the judgment of the incident commander, necessitates rapid intervention and referrals for humanitarian services such as : Grief management Shelter Food acquisition Abused/neglected children Death Drive-by shootings Drownings Fires with displaced occupants Homicides Major traffic accidents Suicides
The goal of the CRT is to allow emergency responders to complete operational duties while the CRT team provides humanitarian services. Requests for CRT shall be made through Operations Control Dispatch Section [OCD]. OCD will coordinate notification with the appropriate Police Division. CRT members are identifiable by their jackets and picture identification. They are instructed to report to the incident commander upon their arrival.
Any questions regarding the CRT may be directed to the Bureau of Human Resources, Bureau Liaison Officer, [2131 485-3396.
\,
-.
9 '
COMMUNITY EMERGENCY RESPONSE TEAM [CERT] The Community Emergency Response Team [CERT] are civilian volunteers [trained by the Fire Department] who assist their communities during the initial phase of a disaster, e.g., major earthquake. The purpose of the CERT Program is to improve community self-reliance and, therefore, survival in the event of a large disaster. It is known that emergency service resources will be depleted, to the extent that some individuals or neighborhoods will need to rely on themselves during the first 24 to 72 hours.
Note: The management of City Volunteer Programs is delineated in LAFD Training Bulletin 71
Revised: 0 112003
PAGE 1 OF 1
MISCELLANEOUS
Members shall use the following terms to indicate the urgency of the situation when requesting police response through Operations Control Dispatch (OCD): Fire Department needs " H E L P
I '
Use this term when there is imminent grave danger to LAFD personnel e.g., members are being attacked, attack is imminent, or other immediate hazardldanger. Assigned to response: ALL AVAILABLE POLICE UNITS IN THE AREA (one unit dispatched Code 3 and other units ASAP) FIRE COMPANY BATTALION CHIEF AND/OR EMS BATTALION CAPTAIN (if EMS incident)
Fire Department needs " A S S I S T A N C E
"
Use this term when there is a large hostile crowd and apparent danger to LAFD personnel or apparatus. Assigned to response: ALL AVAILABLE POLICE UNITS IN THE AREA (one unit dispatched Code 2 and other units ASAP) BATTALION CHIEF AND/OR EMS BATTALION CAPTAIN (if EMS incident)
"BA CK
- U P " the Fire Department
Use this term when there are belligerent individuals and a likelihood of physical altercation. Assigned to response: ONE POLICE UNIT ASSIGNED, CODE 2
" M E E T " the Fire Department

Use this term when requesting LAPD to accompany you to a known "trouble area" or when the Incident Commander requests LAPD for traffic or crowd control. Assigned to response: ONE POLICE UNIT ASSIGNED, CODE 2
Revised: 512005
Section I: Field Procedures I Protocols
MISCELLANEOUS
+ +
THE HIGHEST RANKJNG MEDICAL AUTHORITY on scene (generally a paramedic) is responsible for the overall.medical care rendered to patients. The Incident Commander is responsible for scene management, this includes: Scene Safety Resource Allocation Communications In order to effectively supervise EMS incidents, officers are expected to have a clear understanding of-and the ability to apply-the following: Department of Health Services policies and procedures (Prehospital Care Policy Manual, LAFD Book 33):
1 1 1
1
802 806 808 814 834 502, 508, 5 10, 511, 512, 515, 518,519,520 822,829
1 1 1
1
EMT- 1 Scope of Practice Procedures Prior to Base Hospital Contact Base Hospital Contact and Transport Criteria Deteminatioflronouncement of Death in the Field Patient Refbsal of Treatment or Transport Patient Destination Policies Suspected Abuse Policies and Procedures
I I 1
1
BODY ARMOR VESTS

The BODY ARMOR VEST shall be donned prior to entering a potentially hostile environment. Protection from an attack depends on concealment of the vest so the attacker cannot purposefblly aim at or attack the unprotected area of the body. The vest shall be covered by a brush jacket, EMS safety coat, or firefighting turnout coat. Members shall wear their vests to the following incidents:
+ + + +
Assault with a Deadly Weapon (ADW) Domestic Violence 1 Family Dispute Shooting Stabbing I Cutting
+ + + +
Sniper Incident 1 Police Standby Tactical Alert Incidents in Known "Trouble Area" Other Violent Crimes or Conditions
N d : A vest may be worn anytime a member feels it is necessary.

Revised: 512005
PAGE2 OF 3
Section I: Field Procedures 1 Protocols
MISCELLANEOUS
MEDICAL WASTE DISPOSAL Before leaving the scene collect all usedcontaminated materials and place in zip-lock bags for discard in the biohazard containers at the hospital. Place the disposable sharp supplies into a puncture resistant container. Leave these containers at the receiving hospital when 314 fbll and secured properly.
Revised: 512005
PAGE 3 OF 3
Section I: Field Procedures I Protocols

7
MANAGEMENT OF MULTIPLE VICTIM INCIDENTS

Normally BLS resources will not have the responsibility of medical incident control of multiple victim incidents. However, they may be the first resource on the scene of such an incident. An ALS resource shall be requested for incidents involving the transport of five or more patients and for patients whose condition meets the Patient Resolution Guide (PRG) criteria. The BLS resource shall obtain the following assessment information and initiate patient triage tags prior to the arrival of the ALS resource. (Refer to Book 35?Section 1.1,START; U F D Book 70, Multi-Casualty Incident Procedures; DHS, Reference No. 519.)
+ +
t
ROLE OF THE PROVIDER AGENCY: Institute ICS as necessary. Implement START as necessary. Establish communication with either the MAC or base hospital for the purpose of patient destination andor medical direction. In general, the Medical Alert Center (MAC) should be contacted for 10 or more patients and the base hospital for less than 10 patients. Additional BLSIALS transporting units may be requested fi-om Operations Control Dispatch as necessary. Request?if necessary?the hospital based medical resources from the MAC?as outlined in DHSyRef. No. 8 17?Hospital Emergency Response Team (HERT). PROVIDE THE FOLLOWING SCENE INFORMATION TO THE MAC OR BASE HOSPITAL,: N A T U m OF INCIDENT
SEVERITY STATUS: estimated number of immediate?delayed?minor, and deceased patients. If indicated?include total number and category of pediatric patients. RECEIVING FACILITIES closest to location to include trauma centers?PTCs, PMCs, and EDAPs.
v @ PROVIDE THE FOLLOWING PATIENT INFORMATION AS TIME PERMITS: v v 1. Patient number [e.g., patient # 3 of 81 '# 2. Chief complaint v v 3. Age v 4. Gender v 5. Brief patient assessment v v 6. Brief description of treatment provided v 7. Sequence number v Transporting provider and unit number?destination, and ETA 8. '# v v v
vvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvv.
~ * A * A * A * A * A * A * A * A * A * A * A * A * A * A * A * A * A * A * A * A * A * A * A * A * A * A * A * A * A * A * A * A * A * A * A * A * A * A * A * A * A
Revised: 512005
PAGE1 OF 2
Section I: Field ProcedureslProtocols
MCI EMS REPORT SHORT FORM
The Multiple Casualty Incident (MCI) Short Form has been developed by the Los Angeles County EMS Agency as an optional form for use by providers in situations where multiple patients are encountered on scene. The form is a "shortened" version of the Los Angeles County EMS form that encompasses the essential data for the incident while providing a valuable timesaving tool to providers for multi-patient incidents. The MCI short form may be used in place of the standard EMS Report Form in MCl's.
Page one
Page one (back copy) Patient Release
When more than ten (10) patients are encounteredl the provider has the option of using the MCI Short Form. When this form is usedl a standard EMS Report Form (F-902M) does not need to be filled out. During a mass casualty incidentl the MCI Short Form can be used as a standalone forml used along with a triage tagl or used in place of a triage tag (these options are at the discretion of the department or provider). (Refer to Departmental Bulletin No. 04-19) Each MCI EMS Report Short Form can accommodate up to four patients and is formatted in quadruplicate. The back of the first page allows the patient to release the Fire Department from liability. Use this section ONLY when patients that DO NOT meet the criteria of the LAFD PRG or the LAFD Book 33, Ref. No. 808 * are released from the scene. The fourth page has an adhesive backing and could be placed on the patient for tracking. Once the patient is released from the scenel the patient can keep the adhesive copy for their records. This adhesive copy can also be used as a record for the receiving facility! if the patient seeks medical treatment on their own. The MCI EMS Report Short Form will be carried by all companies and will be included in the MCI packet.
* Patients who meet the above criterial require an EMS Report Form F-902M
completion and base hospital contact.
Revised: 512005 PAGE 2 OF 2
Section 2: Patient Transportation 1 Destination
LAFD PATIENT DESTINATION GUIDELINES
prepared to receive emergency cases and administer emergency care appropriate to the needs of the patient, in the absence of "decisive factors to the contrary." 4 ALS units utilizing Standing Field Treatment Protocols (SFTPs) shall transport patients in accordance with this policy. 4 The most appropriate health facility for a patient may be that facility which is affiliated with the patient's health plan. Depending upon the patient's chief complaint and medical history, it may be advantageous for the patient to be transported to a facility where helshe may be treated by a personal physician and/or the individual's personal health plan where medical records are available. 4 The MAR facility may or may not be the closest facility geographically. Transport personnel shall take into consideration traffic, weather conditions, or other similar factors which may influence transport time when identifying which hospital is most accessible. + Patients shall @ be transported to a medical facility that has requested diversion due to "Internal Disaster."
PATIENTS TRANSPORTED BY BLS PERSONNEL

Stable patients requiring only basic life support (BLS) shall be transported to the MAR, regardless of its diversion status (Exception: Internal Disaster). For pediatric patients, the MAR is the most accessible Emergency Department Approved for Pediatrics. For perinatal patients, the MAR is to be the most accessible Perinatal Center. BLS personnel may honor patient requests provided that the patient is stable, requires basic life support measures only, and the ambulance is not unreasonably removed from its primary area of response.
I
- Transport patients to the MAR unless:

The base hospital determines that a more distant hospital is more appropriate to meet the needs of the patient. The patient meets criteria or guidelines for transport to a specialty care center. The patient requests a specific hospital [provided the patient's condition is considered stable to tolerate additional transport time, the receiving hospital agrees to accept the patient, and the EMS provider has determined that such a transport would not unreasonably remove the unit from its primary area of response]. * If transport to the desired hospital involves an extended transport time [> 20 min.] notify OCD of the extended time and contact the receiving facility to determine if they will accept the patient. * If the desired hospital is unreasonably far, request the EMS Battalion Captain. N A : On an "as needed basis", the EMS agency may extend maximum transport time. grequests cannot be honored, the provider should attempt to arrange for alternate transportation i.e., private ambulance. ALS units may be directed to an alternate "open" facility when the medical facility has requested diversion of patients requiring ALS, if:
* * *
* * *
The patient does not exhibit an uncontrollable problem in the field (e.g., unmanageable airway, uncontrolled hemorrhage). The ALS unit estimates that it can reach an alternate facility within 15 minutes (Code 3) from the incident location. There are no "open" facilities within this time frame, ALS units shall be directed to the MAR regardless of its diversion status (Exception: Internal Disaster). N : On an "as needed basis,'' the maximum transport time may be extended.
Revised: 512005
PAGE 1 OF 1
CALIFORNIA CENTINEIA FREEMANMEMORIAL CAMPUS

-
ADULT ADULT ADULT
12 & OLDER
16 & OLDER PEDIATRIC
- -
COMMUNITY OF LONG BEACH IACIUSC LITTLE COMPANY OF MARYTORRANCE L I E COMPANY OF MARY SAN PEDRO
1
I
ADULT
I
I
PEDIATRIC
ADULT
ADULT ADULT
PEDIATRIC
1
1 1
1 1
SAN GABRIEL VALLEY SANTAMONICAIUCLA
I I
14 & OLDER
PEDIATRIC
"Sexual Assault" refers to patients who state they were sexually assaulted or if EMS personnel suspect the patient was a victim of sexual assault. Prehospital personnel shall notify the local law enforcement agency of sexual assault victims regardless whether the patient complains of physical injuries. EMS personnel, in conjunction with law enforcement, are highly encouraged to transport suspected sexual assault patients, who deny physical injuries, to a designated SART Center. ( D M Reference No. 508)
Revised: 512005
PAGE 1 OF 2
Trauma patients shall be secured and transported from the scene as quickly as possible, consistent with optimal trauma care. EMT-Ps shall make base hospital contact with the area's trauma hospital, when it is also a base hospital, on all injured patients who meet Base Contact and Transport criteria, trauma triage criteria and/or guidelines, or in the paramedic's judgment it is in the patient's best interest to be transported to a trauma hospital. Hospital contact shall be accomplished in such a way as not to delay transport. Patients who fall into one or more of the following categories are to be transported directly to the area's designated trauma hospital, if transport time does not exceed 20 minutes. If existing field resources at the time of transport allow, patients may be transported an additional 10 minutes (to a maximum of 30 minutes). Transport pediatric trauma patients to the designated PTC. (DHS, Reference No. 506)
Systolic Blood Pressure: Adults < 90 Children < 70 Abnormal capillary refill
Penetrating injury to neck Diffuse abdominal tenderness Patients surviving falls from heights > 15 feet Intrusion of motor vehicle into passenger space
1 No spontaneous eye opening

Penetrating cranial injury Penetrating thoracic injury within
Blunt injury to chest with unstable chest wall (Flail chest)
I
Cardiopulmonary arrest with penetrating torso trauma Blunt head injury associated with altered consciousness (GCS equal to or less than 14, excluding patients < 1 year old), seizures, unequal pupils, or focal neurological defecit Open or closed injury to the spinal column associated with sensory deficit or weakness of one or more extremities
Mechanism of injury is the most effective method of selecting critically injured patients before unstable vital signs develop. Paramedics and base hospital personnel shall consider mechanism of injury when determining patient destination. Transportation to a trauma hospital is advisable for:
* * * * *
Survivors of vehicular accidents (in which fatalities occurred) who complain of injury Pedestrians struck by automobiles Patients ejected from vehicles Patients requiring extrication The very young, very old, and patients with precarious previous medical histories
The following extremis patients require immediate transport to the most accessible receiving (MAR) facility:
* * *
Patients with an obstructed airway Cardiac arrest from traumatic injuries (Exception: Transport a penetrating torso injury to a Trauma Center) Patients whose lives would be jeopardized by transportation to any but the most accessible receiving (MAR) facility, as determined by the base hospital personnel
PAGE 2 OF 2
Revised: 512005
When base hospital contact cannot be made, for any reason, paramedics shall decide the destination for trauma patients using the guidelines set forth. BLS personnel shall transport patients to the most accessible receiving (MAR) facility
/
trauma catchment/boundary area is a geographical area surrounding a trauma hospital in which the trauma hospital has agreed to accept trauma patients. The boundaries may either be defined by streets1 freewaysllandmarks or transport time. (DHS, Reference # 504)
Secure Catchment Boundaries1 Area: A catchment area around a trauma hospital strictly defined by streetslfreeways or other physical landmarks. Hospitals with secure catchment areas will only accept trauma patients from incident locations within the defined area. transport time (i.e., a hospital will accept patients who can be transported to its facility within a 30-minute, Code-3 transport time). The boundaries of a trauma hospital with an open catchment area will vary throughout any given day due to variations in weather and traffic patterns.
* Open Catchment BoundariesIArea: A catchment area around a trauma hospital defined by
ALS personnel responsibilities include: (1) Maintaining current knowledge of which geographic areas are securelopen catchment areas or areas undesignated for trauma within the assigned area; (2) Advising the base hospital of the designated trauma hospital covering the incident location when making base contact on a trauma patient.
SECURE Catchment 1 Boundaries for ADULT and PEDIATRIC Trauma Patients:

Henry Mayo Newhall Memorial St. Francis Medical Center Northridge Medical Center-Roscoe Campus Huntington Memorial (PMC) St. Mary Medical Center (PMC)
I SECURE Catchment 1 Boundaries for ADULT and

OPEN Catchment I Boundaries for PEDIATRIC Trauma Patients:
Cedars-Sinai Medical Center (PMC ,PTC) Long Beach Memorial (PMC, PTC) UCLA Medical Center (PMC, PTC) California Medical Center
F ~ ~ a t c h m eI n Boundaries t for Trauma Patients:

Childrens Hospital L. A. (PMC, PTC) HarborIUCLA Medical Center (F'MC, PTC) LACAJSC Medical Center (PMC, PTC) Providence Holy Cross
Trauma patients from incidents occurring in an undesignated area shall be transported to: * The assigned Air Ambulance Trauma Transport Program hospital (Antelope ValleylEast County only); or * The closest/open County-operated trauma hospital within the 30-minute transport guidelines, by groundlair; or * The most accessible receiving hospital (Extremis) (EDAPfor pediatric patients).
Revised: 512005
PAGE
1 OF 2
139 145 248 438
CEDARS SINAI
CHILDRENS
HARBOR
LA
PAGE632-J1
PAGE
PAGE
1
TORRANCE LA
1
LONG BEACH
594-A4 764-A6
635-B3
UCLA
LAC~USC
PAGE
PAGE
533
818
LONG BEACH MEMORIAL UCLA MEDICAL CENTER
792-E2
632-B2
LA
PAGE
All Pediatric Trauma Centers (PTCs) have an OPEN trauma catchment area for pediatric trauma patients. Pediatric patients (14 years of age or younger), who meet Trauma Center Criteria and/or Guidelines, shall be transported to a designated PTC
133 139 145 248 270 305
CALIFORNIA
CEDARS-SINAI
TRAUMA
TRAUMA PMC
EDAP
EDAP
PERINATAL
PERINATAL NICU PTC PTC PTC
x x
CHILDRENS HARBOR /UCLA

HENRY MAY0 HOLY CROSS
PMC TRAUMA
TRAUMA TRAUMA
EDAP EDAP
EDAP EDAP
NICU PERINATAL
PERINATAL PERINATAL NICU
PMC
NICU
324
533 571 667 134 818
1 HUNTINGTON MEM.
LONG BEACH MEM. NORTHRIDGE
ST. FRANCIS ST. MARY
1 TRAUMA 1
TRAUMA TRAUMA
TRAUMA TRAUMA
PMC PMC
EDAP EDAP EDAP

EDAP
1 PERINATAL 1 N I C U 1
PERINATAL PERINATAL
PERINATAL PERINATAL
1
PTC
NICU NICU
NICU NICU
PMC
EDAP
UCLA
1 USC
TRAUMA
1 TRAUMA 1
PMC
PMC
1
EDAP
EDAP
PERINATAL
NICU
PTC
x x x x x
I
438
1 PERINATAL 1 N I C U 1 PTC 1
Revised: 512005
PAGE 2 OF 2
- -
CALIFORNIA MEDICAL CENTER [CALI CEDARS SINAI MEDICAL CENTER [CSM]

--
ADULT ADULT PEDIATRIC PEDIATRIC ADULT ADULT ADULT ADULT ADULT ADULT ADULT ADULT ADULT ADULT PEDIATRIC PEDIATRIC PEDIATRIC PEDIATRIC
CHILDRENS HOSPITAL OF LOS ANGELES [CHH] HARBOR I UCLA MEDICAL CENTER [HGH] HENRY MAY0 NEWHALL MEMORIAL [HMNI PROVIDENCE HOLY CROSS MEDICAL CENTER [HCHI
1 1
HUNTINGTON MEMORIAL HOSPITAL [HMH] LAC I USC MEDICAL CENTER [USC] LONG BEACH MEMORIAL MEDICAL CENTER [LBM] NORTHRIDGE HOSPITAL MEDICAL CENTER [NRHI ST. FRANCIS MEDICAL CENTER [SFM] ST. MARY MEDICAL CENTER [SMM] UCLA MEDICAL CENTER [UCL]
Revised: 0512005
PAGE 1
of 26
LA C O U N T Y T R A U M A CENTERS
Revised: 512005
PAGE
2 of 26
CALIFORNIA MEDICAL CENTER

TRAUMA CENTER CATCHMENT AREA
DESTINATION CRITERIA
OPEN catchmentl boundaries for PEDIATRIC trauma patients
and
SECURE catchmentl boundaries f o r ADULT trauma patients.
1 LEGEND
THOMAS GUIDE MAP
BOOK PAGE
CAL
CALIFORNIA
133
EDAP, PERINATAL, TRAUMA, SART
634-D6
Revised: 05/2005
PAGE 3
of 26
"1
CALIFORNIA MEDICAL CENTER

California Medical Center Trauma Center Catchment Area
PHASE 2
Target Date: 02101105
CAL
CaliforniaMedical Center
TRAUMA CENTER
TRAUMA AREA BOUNDARIES FREEWAYS M A J O R STREETS
NORTHERNBOUNDARY Sanla Monica (10) Freeway Western Avenue
EASTERNBOUNDARY Central Avenue
SOUTHERNBOUNDARY Century Blvd (PHASE 2) WESTERNBOUNDARY Crenshaw Boulevard
Crealed: 1110Z041PLN
Revised: 0512005
PAGE 4
of 26
"1
CEDARS-SINAI MEDICAL CENTER

MULHOLLAND DR
CAHUENGA PASS
GRIFFITH PARK AREA
(PARAMEDIC / BASE HOSPITAL JUDGEMENT)
SANTA MONICA
(10) FREEWAY (10) FREEWAY
MOTOR AVE
1 SANTA
MONICA
patients
OPEN catchment1 boundaries for PEDIATRIC trauma

and
SECURE catchment1 boundaries for ADULT trauma patients.
THOMAS GUIDE MAP BOOK PAGE
CSM
UCL
CEDARS SINAI UCLA
139
PMC, EDAP, PERINATAL, TRAUMA, PTC
632-J 1 632-B2
818
CHH
cH'LDRENs
HOSPITAL
145
PMC, EDAP, PEDIATRIC TRAUMA CENTER (PTC)
5 94-A4
Revised: 0512005
PAGE 5
of 26
CEDARS-SINAI MEDICAL CENTER

Revised: 0712004
PAGE
6 of 26
/ UCLA HOSPITAL
CENTER CATCHMENT AREA
Harbor 1 UCLA Medical Center has a n OPEN catchment area and will accept patients w h o can be transported t o its facility within a 30-minute, Code-3 transport time.
The times may vary throughout any given day because of variations in weather and traffic patterns.
1 LEGEND
HARBOR 1 UCLA HOSPITAL

Revised: 0512005
PAGE 8 of 26
HENRY MAY0 NEWHALL MEMORIAL HOSPITAL

SECURE catchment area for ADULT and PEDIATRIC trauma patients.
1
1
LEGEND
HMN
HENRY M A Y 0 NEWHALL PROVIDENCE HOLY CROSS NORTHRIDGE
1 270
EDAP, PERINATAL, TRAUMA
I1 I1
HcH
NRH

I
530-J2
Revised: 0712004
PAGE
9 of 26
HENRY M A Y 0 NEWHALL MEMORIAL HOSPITAL

,-
Revised: 0312003
PAGE
10 of 26
6.b PROVIDENCE HOLY CROSS MEDICAL CENTER

"1
Providence Holy Cross Medical Center has an OPEN catchment area and will accept patients who can be transported t o its facility within a 30-minute, Code -3 transport time.
The boundaries will vary throughout any given day because of variations in weather and traffic patterns.
LEGEND
I I
HcH
PROVIDENCE HOLY CROSS CHILDRENS HOSPITAL NORTHRIDGE HENRY MAY0 NEWHALL
305 145
I
1
I
1
1
501-HI 5 94-A4
cHH
PMC, EDAP, PTC

--
NRH
571
I I
HMN
530-J2 4554%
Revised: 05/2005
PAGE 1 1
of 26
PROVIDENCE HOLY CROSS MEDICAL CENTER

Revised: 0312003
PAGE
12 of 26
HUNTINGTON MEMORIAL HOSPITAL

SECURE catchment area for ADULT and PEDIATRIC trauma patients.
A secure catchment area is strictly defined by streetdfree ways or other physical landmarks.
LEGEND
HMH
HUNTINGTON MEMORIAL
LAC/USC MEDICAL
324
438
PMC, EDAP, PERINATAL, TRAUMA
565-H6 635-B3
USC
PMC, EDAP, PERINATAL, TRAUMA, PTC, SART
Revised: 0512005
PAGE
1 3 of 26
HUNTINGTON MEMORIAL HOSPITAL

COUNTY
Revised: 0312003
PAGE 14 of
26
LAC 1 USC MEDICAL CENTER

1
LEGEND
OPEN catchment area for ADULT and PEDIATRIC trauma
patients.
THOMAS GUIDE MAP BOOK PAGE PMC, EDAP, PERINATAL, TRAUMA, PTC, sART
USC
LAC/USC MEDICAL
438
635-B3
HMH
HUNTINGTON MEMORIAL CHILDRENS HOSPITAL
324 145
PMC, PERINATAL, EDAP, TRAUMA
565-H6 594-A4
CHH
PMC, EDAP, PEDIATRIC TRAUMA CENTER
Revised: 0312003
PAGE
15 of 26
LAC 1 USC MEDICAL CENTER

Revised: 0512005
PAGE
16 of 26
LONG BEACH MEMORIAL HOSPITAL

ORANGE COUNTY LINE
SECURE catchment area for ADULT trauma patients
OPEN catchment area for PEDIATRIC trauma patients.
LEGEND
I
1
LBM SMM
SFM
I
1
LONG BEACH MEMORIAL
1 1
533

795-E2
795-~6 705436
ST. MARY MEDICAL

ST. FRANCIS MEDICAL
1 134 1
1 1
667
Revised: 0512005
PAGE
17 of 26
LONG BEACH MEMORIAL HOSPITAL

Revised: 0712004
PAGE
18 of 26
NORTHRIDGE MEDICAL CENTER

SECURE catchment area for trauma
patients and will accept patients w h o can be transported t o its facility within a 30-minute, Code -3 transport time.
LEGEND
s
PROVIDENCE HOLY CROSS NRH NORTHRIDGE
5 0 1- H I 530-J2
Revised: 0712004
PAGE
19 of 26
NORTHRIDGE MEDICAL CENTER ROSCOE

Revised: 0712004
PAGE
20 of 26
ST. FRANCIS MEDICAL CENTER

SECURE catchment area for trauma
patients and will accept patients who can be transported to its facility within a 30-minute, Code - 3 transport time.
LEGEND
SFM
ST. FRANCIS MEDICAL
667
705-B6
Revised: 0512005
PAGE 2 1 of 26
S T . FRANCIS MEDICAL CENTER

Revised: 0512005
PAGE 22 of 26
ST. MARY MEDICAL CENTER

SECURE catchment area for trauma patients and will accept
patients who can be transported t o its facility within a 30-minute, Code -3 transport time.
1 LEGEND
sMM
LBM
ST. MARY MEDICAL LONG BEACH MEMORIAL
1 134 1
533

PMC, EDAP, PERINATAL~TRAUMA,PTC
795-~6
795-E2
Revised: 0512005
PAGE 23
of 26
ST. MARY MEDICAL CENTER

Revised: 0712004
PAGE
24 of 26
UCLA MEDICAL CENTER

area for
OPEN catchment
PEDIATRIC trauma patients

and patients.
SECURE catchment area for ADULT trauma
LEGEND
CSM
CEDARS-SINAI NORTHRIDGE UCLA
139
632-J 1 530-J2 632-B2
NRH
57 1
EDAP, PERINATAL, TRAUMA,

EDAP, PMC, PERINATAL, TRAUMA, PTC
UCL
818
Revised: 0512005
PAGE
25 of 26
UCLA MEDICAL CENTER (UCL)

Pacific Ocean
Revised: 0512005
Page 26 of 26
Section 2: Transportation 1 Destination
TRAUMA CENTER DIVERSION

\
When the designated trauma hospital requests diversion to trauma, transport the patient to: The closest open County-operated trauma hospital within the 30-minute transport guidelines, by ground or by air; The closest open trauma hospital with an open catchment area within the 30-minute transport guideline by ground (DHS Reference # 504)
For multiple victim incidents (five or more patients), secure catchment boundaries shall be adhered to. It is understood that during a multiple victim incident, as a result of normal triage procedure, trauma patients may ultimately be transported to a trauma hospital as the next closest facility (crossing the catchment/ boundary) as receiving hospitals in the surrounding geographic area of the incident are utilized to their maximum capacity. Added to the guidelines for identifying critically ill or injured pediatric patients requiring transport to a PMC is ALTE (Acute Life Threatening Event). In 2003, the new category of Pediatric Trauma Center (PTC) was added to the list of Specialty Care Centers. Pediatric patients meeting Trauma Center CriteriaIGuidelines will be transported to the most accessible PTC that may be reached within 30 minutes. In cases when a PTC cannot be reached within this time frame, transport to an adult trauma center.
EDAp / PMC / PTC
Factors to consider prior transport to an EDAP, P M C , or a PTC:
* * * *
Severity of illness or injury and stability of the child's condition Current status of the pediatric receiving facility Anticipated transport time Destination request by family or physician if patient's condition allows
Does not meet PMCRTC transport Transport time to PMC is > 30-min. BLS transport when ALS unit is not available Uncontrollable, life threatening situation ( e.g., unmanageable airway or uncontrollable hemorrhage, respiratory or cardiac arrest) (Refer to the PRG, Principle)
Critically ill (MEDICAL) Severe respiratory distress Cyanosis ALTE 2 12 months of age Persistent altered mental status Status epilepticus Cardiac dysrhythmia
Critically injured (TRAUMA) Trauma criteria and1 or guidelines * Transport time does not exceed 30 minutes *
For patients who meet DHS Ref.# 506
Transport to the most accessible Perinatal Center: Patients who are at least 20 weeks pregnant and who appear to be in active labor or have perinatal complications, chief complaint is related to the pregnancy, and injured perinatal patients who do not meet trauma criteria or guidelines. For patients who have made previous arrangements for OB care, honor patient destination request if: Patient condition permits such transport, transport to requested OB facility would not exceed 20 minutes, and would not unreasonably remove the transporting unit from its area of primary response. (DHS, Reference # 5 11)
Revised: 0512005
PAGE 1 OF 1
BURN PATIENTS
Destination for patients sustaining bum injuries shall be determined as follows:
* *
Patients who meet trauma or PTC criteria and/or guidelines shall be transported to the appropriate trauma hospital or PTC. Patients who do not meet trauma or PTC criteria and/or guidelines shall be transported to the most accessible receiving (MAR) appropriate for their age. (DHS, Reference 5 12)
Note: Firelighter's, who sustain bum injuries, that do not meet base station contact criteria, shall be TAKEN DIRECTLY to either the Grossman Burn Center at Sherman Oaks Hospital or Torrance Memorial Hospital Burn Center.
To expedite the appropriate care associated with the complexities of bums when a firelighter sustains a bum injury, no matter how slight, the following shall be adhered to :
+
4
Firelighter medically evaluated by paramedics. Request for the concerned EMS Battalion Captain shall be made through OCDS. Transport consistent with DHS, Reference 512. However, when the bum injury does not meet base contact criteria, the member shall be transported directly to one of the above bum centers.
This is particularly directed at minor bums that are recognized as a first-degree with high probability of progressing to a second-degree and any second-degree bum. Serious bums require base contact as noted in DHS Reference No 808. Bums secondary to or associated with injuries meeting trauma center criteria shall be transported to a trauma center prior to a bum center.
DECOMPRESSION
Paramedics should simultaneously establish base hospital contact with LACIUSC Medical Center and the Medical Alert Center (MAC) via the Hospital Emergency Administrative Radio (HEAR) for any patient suspected of having a decompression emergency. LAC/USC Medical Center will provide medical orders for patient care and determine if the patient should be transported directly from the incident location to a hyperbaric chamber. MAC will determine which hyperbaric chamber is most appropriate to the needs of the patient and coordinate transportation to the chamber for the patient and medical personnel. (Factors considered include: patient condition, distance, altitude, ETA of available transportation, and limitations of various aircraft.) *Obtain dive incident history of the patient and dive partner, if able. 'Coordinate patient transportation to the appropriate receiving facility. *Retrieve patient's dive equipment (e.g., regulator, tank, gauges, weight belt, etc.) and transport with patient. As a general rule, the integrity of the dive equipment should be maintained and not tampered with except by investigating authorities. (Refer to DHS, Reference No. 518.)
N A : If MAC cannot be accessed directly fi-om the field and another base hospital is contacted, that base hospital should contact MAC for coordination of treatment and transport.
Revised: 512005
PAGE 1 OF 2
DECOMPRESSION
Paramedics should simultaneously establish base hospital contact with LAC/USC Medical Center and the Medical Alert Center (MAC) via the Hospital Emergency Administrative Radio (HEAR) for any patient suspected of having a decompression emergency. LACNSC Medical Center will provide medical orders for patient care and determine if the patient should be transported directly from the incident location to a hyperbaric chamber. MAC will determine which hyperbaric chamber is most appropriate to the needs of the patient and coordinate transportation to the chamber for the patient and medical personnel. (Factors considered include: patient condition, distance, altitude, ETA of available transportation, and limitations of various aircraft.)
* Obtain dive incident history of the patient and dive partner, if able. * Coordinate patient transportation to the appropriate receiving facility.
Retrieve patient's dive equipment (e.g., regulator, tank, gauges, weight belt, etc.) and transport with patient.
As a general rule, the integrity of the dive equipment should be maintained and not tampered with except by investigating authorities. (Refer to DHS, Reference No. 518.)
,)
N A : If MAC cannot be accessed directly from the field and another base hospital is contacted, that base hospital should contact MAC for coordination of treatment and transport.
Revised: 1212001
PAGE
2 OF 2
PATIENT DESTINATION GUIDELINES

EMS personnel shall use the following guidelines when making patient destination decisions:
PATIENTS 0-14 YEARS OLD: Transport to themost accessible EDAP I PMC I PTC
-a '
-V
,
1
1 PATIENTS 15 YEARS or OLDER: Transport to the most accessible receiving (MAR) facility 1
Emergency Departments Approved for Pediatrics (EDAP) Harbor/UCLA Medical Center * * + Robert F. Kennedy
Brotman
Henry Mayo Newhall Memorial Huntington Memorial
St. Francis
St. John's
California Cedars Sinai
**
**
Kaiser - Woodland Hills
St. Mary Medical Center

San Gabriel Valley Santa Monica - UCLA Simi Valley Torrance Memorial
Centinela Freeman-Centinela KingIDrew

Centinela Freeman-Memorial
LAC/USC Medical Center ** +

Little Company of Mary-San Pedro Little Company of Mary-Torrance
Childrens Hospital LA * * +
Columbia - West Hills Downey Regional East LA Doctors Encino Tarzana - Tarzana Gardena Memorial Glendale Adventist Glendale Memorial
Long Beach Memorial

Pacifica of the Valley
**
UCLA Medical Center * * +

Valley Presbyterian Verdugo Hills White Memorial
Northridge - Roscoe Campus Providence Holy Cross

Providence St. Joseph
** PMC
+ PTC
Italics denotes "Trauma Center"
If the patient is stable, honor the patient's or physician's request. Normally, the transportation time shall not exceed 20 minutes (non-emergency). Extended transport times require authorization from OCD.
Internal Disaster: Emergency Room (ER) Saturation: Neuro, CT Scan, Trauma, PTC:
No BLS or ALS Transport No ALS Transport No ALS Transport (for patients requiring these specialties)
"Service Area" hospitals may @ divert except for INTERNAL, DISASTER. Diversion transportation time is 15 minutes (Code 3) to an open emergency room (ER). If ER is open, within the 15 minute transport time, transport to the most accessible ER.
1 '
Revised: 512005
PAGE 1 OF 1
TRANSPORTING PATIENTS IN CUSTODY
Utilize the following procedural guidelines when requested by LAPD (or other law enforcement agencies) to transport a patient in custody:
+ + + +
A law enforcement officer shall ride in the back of the rescue ambulance with the patient at all times. Patients shall be transported to the most accessible medical facility. (Patient's from the Central Jail or Parker Center shall be transported to LACAJSC's 13th floor Jail Ward, unless in extremis). Restrained patients shall not be transported in the prone (facelchest downward) position. Such patients shall be transported in the left lateral position. Restraint equipment, applied by EMS personnel, must be either padded leather or soft restraints. Restraint methods must allow for quick release. (DHS Reference # 838) Restrained extremities shall be evaluated for pulse quality, capillary refill, color, nerve, and motor status every 15 minutes or less.
REQUIRED DOCUMENTATION ON THE EMS REPORT FORM (F-902M) SHALL INCLUDE: The type of and reason restraints were needed. Identity of agencylmedical facility applying restraints. Assessment of the circulatory and neurological status of the restrained extremities. Any abnormal findings require the restraints to be removed and reapplied or supporting documentation. Assessment of the cardiac and respiratory status of the restrained patient.
HOSPITAL REFUSAL TO ACCEPT RESCUE AMBULANCE PATIENTS

Personnel encountering serious problems at a hospital emergency room (i.e., refusing patient) shall contact OCD and request an EMS Battalion Captain to respond to their location. It shall be the responsibility of the EMS Battalion Captain to investigate the circumstances and ensure that proper base hospital notification/docurnentation is made. Journal entries of the incident shall be made and the Station Commander notified. Once a patient arrives inside the intended emergency room, the patient shall remain.
Revised: 512005
PAGE 1 OF 1
hospitals have an agreement with the EMS Agency that only those patients within a given boundary will be transported to their facility. Service area hospitals may honor patient requests from outside of their service area; however, they are not obligated to do so. All LAFD ambulances with any ALS or BLS patient, within a defined service area, will transport to the service area hospital, maintaining the service area hospital agreement. (In most instances the service area hospital is also the MAR.)
/-^
1
Patients who meet criteria or guideline for a specialty care center (e.g., EDAP, PMC, Trauma, Perinatal) not provided by the service area hospital, shall be transported to the appropriate specialty care center. Patients exhibiting uncontrollableproblems in the field will be transported to the most accessible medical facility regardless of incident location. Patients from multiple casualty incidents may have to cross boundaries, depending on incident location or direction from the base hospital or Medical Alert Center.
N : -
Service area hospitals shall not be on diversion for any categories other than Internal Disaster.
It is the responsibility of BLS and ALS personnel to recognize the appropriate receiving hospital based on the patient's condition and incident location.
CALIFORNIA MEDICAL CENTER CENTINELA FREEMAN-CENTINELA CENTINELA FREEMAN-MEMORIAL EAST LA DOCTORS GOOD SAMARITAN
EDAP EDAP EDAP EDAP

I
PERINATAL PERINATAL PERINATAL PERINATAL PERINATAL
NICU NICUNICU
NICU
I
MEMORIAL HOSP. OF GARDENA WHITE MEMORIAL MED. CENTER
EDAP EDAP
PERINATAL PERINATAL
1
NICU
Patient requests for transport to a service area hospital when the incident location is outside the hospital's defined service area or inside the service area of another hospital may be honored by:
1 BLS Resource (For BLS patients):

The receiving hospital agrees to accept the patient. The transporting unit is not unreasonably removed from its primary response area.
1 ALS Resource:
Base Hospital concurs that the patient's condition is stable to permit the estimated transpoi-t time. The requested hospital agrees to accept the patient. The transporting unit is not unreasonably removed from its primary response area.
N : *
The receiving hospital may be contacted directly if the ALS unit is transporting a BLS patient.
PAGE 1 OF 1
Revised: 512005
Section 2: Trans~ortation 1 Destination
Good Samaritan Hospital & California Hospital
Good Samaritan Hospital and California Hospital have the above service area boundaries and are divided by Olympic Blvd. If BOTH hospitals are listed as emergency department "SATURATED," adult patients from incident locations: NORTH of Olympic B1vd.-transport to Good Samaritan Hospital. SOUTH of Olympic B1vd.- transport to California Hospital.
1 DESTINATION C R I T E R I A
Rescue ambulance personnel shall access the Mobile Data Terminal (MDT) to determine the hospital emergency department status prior to initiating transport. If either hospital is listed as an emergency department "SATURATED," service area patients shall be taken to the other hospital.
CAI,
California Medical Center

I I
133 EDAP, PERINATAL, NICU

I
I
Thomas Guide Pg. 634-D6
GSH
1 Good Samaritan Hospital 1 220 [PERINATAL, NICU
1 Thomas Guide Pg. 634-D3 1
Revised: 512005
HOSPITAL OF THE GOOD SAMARITAN

&
CALIFORNIA MEDICAL CENTER Service Area
Revised: 512005
PAGE 2 OF 8
Section 2:
Transportation I Destination
Centinela Freeman-Centinela & Centinela Freeman-Memorial
Patients fiom incident locations:
4 Within the "Secondary 4
Service Area'' may be transported to Centinela FreemanMEMORIAL (DFH) o r CENTINELA FREEMAN-CENTINELA (CNT).
West of the 405 Freeway, may be transported to Centinela Freeman- MARINA (DFM).
4 All PEDIATRIC patientsy age 14 or less not meeting pediatric trauma or PMC criteria,
shall be transported to Centinela Freeman- MEMOFUAL Hospital.
All adult patients, age 3 5 2 , with the chief complaint of CHEST PAIN or SYMPTOMATIC DYSRHYTHMIAyshall have A L S transport to CENTINELA FREEMANCENTINELA Permissible EXCEPTIONS to transporting patients to this destination are: d Incidents involving patients requiring transport to a specialty care facility (trauma center or pediatric critical care center). 4 When honoring a patient request in accordance with Department customer service guidelines. d When facility is closed due to internal disaster.
BMC Brotman Medical Center

CNT
172 141 457 153
EDAP EDAPyPERINATAL, NICU
Thomas Guide Pg. 672-Gl Thomas Guide Pg. 703-D4 Thomas Guide Pg. 762-B6
Centinela Freeman-CENTINELA
DFM Centinela Freeman MARINA DFH Centinela Freeman MEMORIAL

kl?W Kaiser-West LA
EDAP, PERINATAL, NICU
Thomas Guide Pg. 703-D2 Thomas Guide Pg. 632-J6
362 PERINATAL
Revised: 512005
PAGE
3 OF 8
Secondary Service Area: The Secondary Service Area will become effective when all receiving hospitals within 15 minutes from the incident location7in the Secondary Service Area7have requested diversion to ED saturation. In this instance, patients may be transported to DFH or CNT.
Manchester Ave. Boundary: When both DFH and CNT have requested diversion due to ED saturation7patients will be transported as follows: Patients NORTH of MANCHESTER Ave. will be transported to DFH. Patients SOUTH of MANCHESTER Ave. will be transported to CNT.
Revised: 512005
Section 2: Transportation I Destination
Memorial Hospital of Gardena
LEGEND
1
EDAP, PERINATAL EDAP, PERINATAL, NICU EDAP, PERINATAL EDAP, PERINATAL, TFUUMA PMC, EDAP, PERINATAL, TRAUMA, PTC
MHG Memorial Hospital of Gardena

CNT Centinela Hospital-CENTINELA KingDrew St. Francis HarborRJCLA
Thomas Guide Pg. 734-A5 Thomas Guide Pg. 703-D4 Thomas Guide Pg. 704-G7 Thomas Guide Pg. 705-B6 Thomas Guide Pg. 764-A6
MLK SFM HGH
Revised: 512005
PAGE
5 OF 8
MEMORIAL HOSPITAL OF GARDENA Service Area
Revised: 512005
PAGE
6 OF 8
Section 2:
Transportation 1 Destination
White Memorial Medical Center (Including E a s t L A D o c t o r s )
While in the White Memorial Service Area, rescue ambulance personnel shall transport to the most accessible, open hospital within the Service Area, e.g., White Memorial Medical Center, East Los Angeles Doctors, or LACAJSC Medical Center..
LEGEND
WMH White Memorial Med.Cent. 970 EDAP, PERINATAL, NICU
Thomas Guide Pg. 635-A4
1 ELA l ~ a sLos t Angeles Doctors 1 157 1 EDAP, PERINATAL

PMC, PERINATAL, NICU, pTc (USE) LAC/USC Medical Center 438 TMw,
1 I
1 Thomas Guide Pg. 635-D7 1
Thomas Guide Pg. 635-B3
Revised: 512005
PAGE
7 OF 8
WHITE MEMORIAL MEDICAL CENTER Service Area
Revised: 512005
PAGE
8 OF 8
Section 2: Patient Trans~ortation 1 Destination
LOS ANGELES COUNTY EMS RECEIVING FACILITIES
1
1
/Al hambra Hospital Beverly Hospital
1
* A *
(626) 570-1606 (323) 726-1222
100 S . Raymond Ave., Alhambra, 91801 309 W . Beverly Blvd., Montebello, 90640 3828 Delmas Terrace, Culver City, 90231
Brotman Medical Center
1 California Hospital Medical Center
* A
1 Cedars-Sinai Medical Center ** A 1 Centinela Airport Medical Center 1 Centinela Freeman-Centinela * A

Centinela Freeman-Marina Centinela Freeman- Memorial
(310) 836-7000
(213) 748-2411 (310) 855-5000
1 1338 S. Hope St, Los Angels, 90015
I 1 1
(310) 673-4660 (310) 823-8911
1 8700 Beverly Blvd., Los Angeles, 90048 1 9601 S. Sepulveda, Los Angeles, 90045 1 555 E. ~ a r d y ~ tInglewood, ., 90301
4650 Lincoln Blvd., Marina Del Rey, 90291 333 N. Prairie Ave., Inglewood, 90301
*A
* **
*A
(310) 674-7050
Century City Hospital (ER CLOSED 4/04) Children's Hospitalo f Los Angeles Coast Plaza Doctors Columbia West Hills Medical Center Downey Regional
(323) 660-2450 (562) 868-3751 (818) 676-4000 (562) 904-5000 4650 Sunset Blvd., Los Angeles, 90027 13100 Studebaker Road, Norwalk, 90650 7300 Medical Center Dr., West Hills, 91307 11500 Brookshire Ave., Downey, 90241
*A *A
* A
1 East Los Anaeles Doctors
JEncino Tarzana Regional -Encino
1 Encino Tarzana Regional -Tarzana

Garfield Medical Center
1 1 1
(323) 268-5514 (818) 995-5000 (818) 881-0800 (626) 573-2222
1 4060 E. Whittier Blvd., Los Angles,90023 1 16237 Venture Blvd., Encino, 91436 1 18321 Clark St., Tarzana, 91356>
525 N. Garfield Ave., Monterey Park, 91754
.
* A
Glendale Adventist Medical Center Glendale Memorial Good Samaritan
* A
(818) 409-8111
1509 Wilson Terrace, ~lendal'e,91206 -
* A
A
* ** A Henry Mayo Newhall Memorial *

Harbor/UCLA Medical Center Huntington Memorial
1
I
(818) 502-1900 (213) 977-2121 (310) 222-2345 (661) 253-8000 (626) 397-5000
. Central Ave., Glendale, 91225-7036 , 1420 S 616 S. Witmer St., Los ~n~eles,~~fl017 ' , ' -
1000 W . Carson St., Torrance, 90509 91355 23845 W. McBean Parkway, ~alencia, 100 W . California Blvd., Pasadena, 91109
* ** A
A
1 Kaiser Hospital - Baldwin Park

Kaiser Hospital Bellflower
1
I
(626) 851-1011 (562) 461-3000
1 1011 Baldwin Park Blvd., BaldwinPark,91706 1

9400 E . Rosecrans Ave., Bellflower, 90706
t
A 1 Kaiser Hospital - South Bay A Kaiser Hospital - Sunset (LA) A 1 Kaiser Hospital - Panorama City A 1 Kaiser Hospital - West Los Angeles
Kaiser Hospital -Woodland Hills Little Company of MayTorrance
(310) 325-5111 (323) 783-4011
1 25825 S. Vermont Ave., Harbor City, 90710 1

I
4867 Sunset Blvd., Los Angels, 96027

a ?
1
A
(818) 375-2000 (323) 857-2000 (818) 719-3800 (310) 540-7676
1
I
1 13652 Cantara St., Panorama City, 91402

I
1 6041 Cadillac Ave., Los ~ n g e I.e ~ 9 . Q w

5601 De Soto Ave., Woodland Hills, 91367 4101 Torrance Blvd.,Torrance, 90503
* A
* A
Revised: 512005
PAGE 1 OF 2
1 Little Company of Mary-San Pedro * 1 Long Beach Community * A

Long BeachMemorialMedicalCenter LAC/USC Medical Center
(310) 832-3311 (562) 498-1000 (562) 933-2311 (818) 364-1555 (323) 226-2622 (310) 668-4321 (310) 532-4200
I I
1300 W. 7th St, San Pedro, 90732 1720 Terrnino Ave., Long Beach, 90804 2801 Atlantic Ave., Long Beach, 90806 14445 Olive View Dr., Sylrnar, 91342-1495 1200 N. State St, Los Angeles, 90033 12021 S. Wilmington Ave., Los Angeles, 90059 1145 W. Redondo Beach Blvd., Gardena,
* ** A
A
LA County Olive View Medical Center
** * A
Martin Luther King JrDrew Medical Center * A Memorial Hospital of Gardena Mission Community Hospital Monterey Park Hospital A
*A
I (818) 787-2222 I 14850Roscoe Blvd., PanoramaC i t y , 91402

(626) 570-9000 900 S. Atlantic Blvd., Monterey Park, 91754
Olympia Medical Center

Pacific Hospital o f Long Beach Pacifica Hospital of the Valley
(323) 938-3161
5925 San Vicente Blvd., Los Angeles, 90019 2776 Pacific Ave., Long Beach, 90806 9449 San Fernando Road, Sun Valley, 91352 15031 RinaldiSt, Mission Hills, 91345 501 S. BuenaVista St, Burbank, 91505
A * A
(562) 595-1911 (818) 767-3310
Providence Holy Cross Medical Center Providence Saint Joseph Medical Center
* A
* A
(818) 365-8051 (818) 843-5111
"1
Saint Francis Medical Center
* A
*
(310) 603-6000 (310) 829-5511 (562) 491-9000 (626) 289-5454 (310) 319-4000 (818) 981-7111
3630 Imperial Highway, Lynwood, 90262:
Saint John's Hospital and Medical Center Saint Mary Medical Center
2103 Santa Monica Blvd., Santa Monica, 90404 1050 LindenAve., Long Beach, 90813
San Gabriel Valley Medical Center
*A Santa M o n i c a - UCLA Medical Center * A
. Santa Anita St, San ~~bri$l,91776> 218 S

1250 Sixteenth St, Santa Monica, 90404
Sherman Oaks Community Hospital
4929 Van Nuys Blvd., Shennan OW, 91403
1 U C L A M e d i c a l C e n t e r * ** A 1 Valley Presbyterian Hospital * A 1 Verdugo Hills Hospital * A

1 White Memorial Medical Center
* * A
1 (310) 825-9111 1 10833 Le ConteAve., Los Angeles, 9@24 1 1 (818) 782-6600 1 15107 Vanowen St, Van Nuys, 91405 1 I (818) 790-7100 1 1812Verdugo Blvd., Glendale, 91208, I (323) 268-5000 1 1720 Cesar Chavez Ave., Lo8 Angeles, 90033 1
PTC
"Italics" Denotes TRAUMA CENTER

EDAP PMC
PERINATAL
**
Revised: 512005
PAGE 2 OF 2
B A T T A L I O N
O F F I C E S
Revised: 712004
PAGE 1 OF 1
>
RECEIVING HOSPITALS SORTED BY EMS BATTALION OFFICE
California, Orthopaedic Glendale Adventist, Glendale Memorial, Huntinaton Memorial Hudson Clinic Centinela Airport Clinic, Centinela FreemanCentinela, Centinela Freeman-Marina, Centinela Freeman-Memorial Children's, Kaiser Los Angeles, Queen of AngelsIHollywood Presbyterian HarborIUCLA, Kaiser South Bay, Little Company of Mary-San Pedro, Little Company of Mary-Torrance, Long - Beach Memorial, Pacific of Long Beach, St. Mary, Torrance Memorial Alhambra, Beverly, East Los Angeles Doctors, Garfield, ~ a i s e Baldwin r park; LACIUSC, Monterey Park, San Gabriel Valley, White Memorial St. John's, Santa MonicaIUCLA, UCLA, Veterans Administration Wadsworth Encino Tarzana-Encino, Sherman Oaks, Valley Presbyterian Good Samaritan Henry Mayo, Kaiser Panorama City, Mission Community, Olive View, Pacifica, Providence Holy Cross, Verdugo Hills Coast Plaza Doctors, Downey Regional, Gardens Memorial, Humphrey Clinic, Kaiser Bellflower, KingIDrew, St. Francis Providence St. Joseph Northridge-Roscoe, Simi Valley Columbia West Hills, Encino Tarzana-Tarzana Kaiser Woodland Hills Brotman, Cedars-Sinai, Century City, Kaiser West Los Angeles, Olympia
PAGE 1 OF 1
39
10
78
14
PAGE 1 OF 1
14
114
A
1 1
3
LAFD RESCUE AMBULANCE LOCATIONS
1 1 1
803
1 1 1
7
1
1 1
2230
N. Pasadena Ave.
1 1 1
Lincoln Heights
1 pg. 595 1 1
A-7
1 (213) 485-6201 , ' 1 (213) 485-6203 1 1
1
5
I
1
108
N.FremontAve.
Bunker Hill
634 F-3
6621
W. Manchester Ave.
Westchester
702 F-3 l(213) 485-6205
1 1
11
430
E. Seventh St.
1 1
1 1 1 1 1
Civic Center
1 1
1
1 1 1
634 F-5
1(213)485-6209
1 1
1
11
I811
1
1
1
11 1 1 8 1 9
11
W.SeventhSt.
Westlake
634 C-3 1(213)485-6211
I I
1 1
1206
S. Vermont Ave.
Pico Heights
634 A-4 l(213) 485-6213
915
W. JeffersonBlvd.
USC Campus
634 B-7 (213) 485-6215
1 1 1
21
1601
S. Santa Fe Ave.
Industrial Eastside
634 H-7
1 (2 13) 485-621 7
1
12229
W. Sunset Blvd.
Brentwood
631 G-3 (310)575-8519
21
11187
E.52ndSt.
South Los Angeles
674 E-4
1 (213) 485-6221 1
1 V824 1 1
26
12
I I
1
9411
Wentworth St.
1 1 1
1
SunlandlShadow His
1 1 1
1
503 D-3
1 (8 18) 756-8624 1 1 (2 13) 485-6226 1 1 (818) 756-9728 1

1 (2 13) 485-6233 1
26
I
1
826 828
I
1
I
3
15
2009
S. Western Ave.
West Adams
633 H-6
11641
Corbin Ave.
Porter Ranch
500 E-1
33
18%
13
I6406
S.MainSt.
South Los Angeles
674 C-6
3 5 1 - I
835
1601
N. Hillhurst Ave.
Los Feliz
594 A-4 l(213) 485-6235
Revised: 512005
PAGE 1 OF
Section 2: Patient Trans~ortation 1 Destination
1 1 1
44
1
1
47
1 1
844
I
1
2
7
1 1410
1 4575
Cypress Ave.
Cypress Park
1
1
595 H-4
(213) 485-6244
1 1 1
47
E. Huntington Dr. S.
1 Monterey Hills
595 D-6 l(213) 485-6247
49
1 V849 I
51
1 400
Yacht St.,Berth 194
1 Wilmington
824 F-1
1(310)548-7549
I
1
51
I
1
I
1
1
1
1 10435
I 4455
Sepulveda
I LAX
I Eagle Rock
1
1
702 0-5
] (213) 485-6251
l(213) 485-6255
1
1
55
55
2 13
E. York Blvd.
594 J-1
1
1
\
57
1 57 1257 1 V857 1
1
59
1 7800
1 11505
S. Vermont Ave.
1 South Los Angeles 1

1 West Los Angeles
704 A-1
1(213)485-6257
1
1
59
1
861
W. Olympic Blvd.
632 B-6
I(310) 575-8559
161
61
1
1
18 15821
4
W.ThirdSt.
1 Park LaBrea
1 Venice 1 watts 1 Mid-City
1
1
1
633 D-1
1(213)485-6261
1
1
1
1 1930
Shell Ave.
671 J-5
l(310) 575-8563
1 1
65 16512651
1
868
13 11525.
E.103rdSt.
704 F-5
l(213) 485-6265
68
68
18
I 5023
W. Washington Bl.
633 D-5
1(213)485-6268
Il-70 1
1
1
15
1 9861
1 681 1
Reseda Blvd.
1 Northridge
1 Canoga Park
1
1
500 J-5
1(818)756-8670
1
1
17
De Soto Ave.
-
530 C-6
l(818) 756-8672
74
74
12
1 7777
- --
Foothill Blvd.
1 Tujunga
1 Cahuenga Pass
1 Studio City
1
1
1
503 H-3 l(818) 756-8674
1
1 1
1 V876 I 1 V878 I
80
5
14
I 31 11
N. Cahuenga Bl.
593 D-1
l(213) 485-6276
1 4230
691 1
Coldwater Cyn. Av
562 E-5
l(818) 756-8678
World Way West

PAGE
1 LAX Crash Rescue 1

2 OF 3
702 E-5
l(213) 485-6280
Revised: 512005
Section 2: Patient Trans~ortation / Destination
1 1
81 83
1 1
81 83
1 1
881
1
1
12 114123 10
Nordhoff St.
1 Arleta 1 1 1
Encino Harbor City
I P ~ . 502
1 1
1
B-7
1 (818) 756-8681 1 1 1 1
I 5001 I
1331
BalboaBlvd.
W. 253rd St.
561 D-3 1(818)756-8683 794 A-4 l(310) 548-7585
1 1
87 89
87 89
1
889
15
14
1 10241
Balboa Blvd.
Granada Hills
501 C-4 l(818) 756-8687
1 1
1 1
1 7063
1 14430
Laurel Canyon Blvd.
1 North Hollywood
532 G-5 l(818) 756-8689
1
1
91
91
1 V891 1
12
Polk St.
482 A-4 l(818) 756-8691
95 97 9
95
4 14
- -
1 10010
International Rd.
LA Airport
702 J-5 l(213) 485-6295
1
9
1 V897 1
1 8021
Mulholland Drive
1 Laurel Canyon
592 J-1 l(818) 756-8697
. !
1 9 910 1 14145
Mulholland Drive
1 Beverly Glen
562 A-7 l(818) 756-8699
103
1 103 1
15
1 18143
Parthenia St.
1 Northridge
531 A-1 l(818) 756-8603
109 Ill 114
I
]
I V909 1
10
I 16500
Mulholland Drive
I Encino Hills
561 E-7 l(818) 756-8609
I 1444
8060
S. Seaside, Berth 256
1 Fish HarborlTenn Is. 1

Van Nuys Airport
824 D-5 l(310) 548-7541
1
,
I
= Variable
Balboa Place-Air Ops
Legend: "V"
Staffing
PAGE 3 OF 3
Revised: 512005
Section 3: Apparatus 1 Equipment . . . .
APPARATUS TOWING / BREAKDOWN PROCEDURES
0630-2300 HOURS 1. Notify OCD and Battalion Commander of status.

2.
1. Notify OCD and Battalion Commander of status.

2.
OCD shall contact the Shops or mechanic to determine: tow, repair, or if a relief apparatus is required.
Company Commander shall determine if field repair or towing is required.
Battalion Commander shall arrange transportation. 3- Company Commander shall arrange for a relief apparatus and change over. 4. OCD shall report time towing contractor was notified. 4. After change over, notify OCD that a tow 5 . Tow to nearest S&M facility; if accident, tow to is needed. Central Shops. 5 - A member shall accompany the apparatus or 6- A member shall accompany the apparatus or meet the contractor at the Shops for security and meet the contractor at the Shops for security to validate the tow invoice. and to validate the tow invoice.
3-
2300-0630 HOURS
1\
2300-0630 HOURS
1.
Notify OCD and Battalion Commander of status. Company Commander shall determine if repairs may be made by members or Heavy Rescue; and if a relief apparatus is required. Update OCD of status. Tow utilizing procedures 5 and 6 above.
Notify OCD and Battalion Commander of status. Company Commander shall arrange for repair or change over to a relief apparatus. Update OCD of status. Store apparatus in quarters overnight and tow utilizing towing procedures above.
2.
'
3.
4.
3,
4.
If the Shops are closed and Rescue Maintenance is not in quarters, contact OCD on the telephone outside of the office for entry. Use the gate keys in the lock box to open the yard and leave apparatus. Leave a note to briefly describe the apparatus type, problems, and status. Secure yard before leaving.
The following information is needed for the tow invoice: 1. 2.

3.
4.
Name of towing service Make, year, and Shop No. of apparatus Address where towing was initiated Date and time tow contractor was notified Time towing service arrived on scene Time towing was completed
5.
6.
Sign the receipt, include your assignment and telephone number, then forward to S&M at: Mail Stop 253. An F-80 is required for the repairs, but not for the towing.
Revised: 1212001
PAGE
1 OF 1
Section 3: Apparatus 1 Equipment
APPARATUS MAINTENANCE
Maintenance procedures are performed periodically based on the pre-described maintenance schedules set forth in Volume 3-710 and Department Log Books. The Station Commander is ultimately responsible for the condition of apparatus under hislher command, but each member shares equally in the responsibility of maintaining Department apparatus. To increase the performance and life of Department apparatus, daily, weekly, monthly, and bi-monthly preventive maintenance checks are preformed. Certain basic procedures in daily maintenance pre-checks on all apparatus shall be accomplished at the beginning of each shift or at any time a change of relief occurs. Refer to LAFD, Book 8, Drivers Training Manual, Module 4. The Preventive Maintenanceform [F-3 771 RA applies to all Rescue Ambulances (active, reserve, and standby) that are serviced by field personnel. It is used to record the preventive maintenance performed and problems discovered. Refer to MOP, Volume 3- 711-48.32. The form is: + Completed monthly by the responsible member. + Original forwarded to Battalion Commander within the first two weeks of each month (prior to Battalion inspection). + Copy retained in Apparatus Log Book until replaced by original from Battalion. + Original retained in Log Book for one year. All needed repairs will be reported as directed in MOP, Volume 4,813-40.40 and 40.50 (this includes brake adjustment, emergency lighting, steering, warning devices, etc.).
Revised: 12/2001
PAGE
1 OF 1
Section 3: Apparatus / Equipment
CAV / NAV
AVI
Available within 60 seconds (1 minute) Available within 180 seconds (3 minutes) Fire Resources Available within 60 seconds (1 minute) ALS 1 BLS Rescue Ambulance
NAV
Not available for dispatch
Mobile Data Terminal (MDT) unit status shall be updated and correct at all times while AVI (Available), CAV (Conditionally Available), or NAV (Not Available). A Journal (F-2) entry shall be made for CAV / NAV status (include times and reason).
Resources that are CAV shall maintain radio watch a t all times.
CHANNEL 4: METRO (RESCUE ONLY) CHANNEL CHANNEL 7: METRO CHANNEL 8: VALLEY
18: FRANK HOTCHKIN

MEMORIAL TRAINING CENTER [FHMTC]
e The amount of time (before the resource will be available to respond - within 1-3 minutes).
Provide the following information to OCD when requesting CAV status:
The CAV status reason: Routine Training

I
37
1 38 1
43
StafFing CAV Other Must Specify Fire Prevention Non-Emergency Move-up Continuing Education Oil Change EMT Training
Required Training Mechanical

--
1 1
44 45 47 48
39 r ~ e t u r n i From n ~ Move-up 40 41
#
I46
1
-
Returning From Incident Community Relations
42
Equipment1 Supplies Restock

-
49
Provide the following information to OCD when requesting NAV status: + The location where the resource will be NAV. (This may be a fire stationsfirst-in district or a location code.) + The NAV status reason: 26 27 29 30 31 32 33 34 35
Revised: 912003
PAGE
1
1
m
1
1
Routine Training EMT Re-certification Decontamination Annual Apparatus Testing NAV Other - Must Snecifi Change Over No Hospital Beds Oil Change Required Training
- -
1
1
I1
1 OF 1
.Section 3: Apparatus 1 Equipment - . . .
OBTAINING A SPARE GURNEY
A cache of spare gurneys is maintained at each EMS Battalion Office. The procedure to obtain a spare gurney is as follows:
* Notify the Station Commander and EMS Battalion office.

* Ascertain the availability of spare gurneys at the EMS Battalion office. * Take the defective gurney to the EMS Battalion office and attach an F-175 tag stating the problem.
* Label the new gurney with your RA designation, using 2%'' red decals.
Place decals on each side panel of the gurney.
* Make appropriatejournal entry when you return to quarters.
Use Extreme Caution at all times when operating gurneys to prevent patient injury andlor private property damage. Particular attention shall be given when: Repositioning into a chair position, moving through confined areas and doorways, transporting combative andlor altered mental status patients, and loading patients inlout of an ambulance. Active measures are required by members to assure the safe position of the patients hands and extremities to prevent injuries.
Revised: 912003
PAGE 1 OF 1
tion 3: Apparatus 1 Equipment
MULTI-CASUALTY MEDICAL SUPPLY CACHE

, \
caches are designed for rapid deployment of emergency medical supplies to a multi-casualty incident, major catastrophe, or at the Incident Commander's discretion. Each cache weighs approximately three1 hundred pounds and consists of six plastic boxes, 12 wooden backboards, and a full complement of dressing and bandaging material; and each cache is designed to provide basic first-aid and EMT-I level treatment for 15 to 50 patients. They are transportable inside Department helicopters, heavy apparatus, plug buggies, and rescue ambulances. The following deployment locations provide for geographic coverage, potential need, and transport considerations:
The Medical Supply Trailer is available for immediate response to disasters, MCI's, or at IC discretion. Can be deployed for "Special Event" venues. They can be towed by any pick-up or larger vehicle with a tow package.
HAZARDOUS MATERIALS C A C H E
) V
HAZARADOUS CHEMICAL AGENT EMERGENCY
For signs and symptoms of Cyanide : poisoning administer Amyl Nitrite in conjunction with decontamination.
+ CYANIDE POISONING EXPOSURE:

Special considerations: Wear PPE and ensure decon procedures are completed prior to treatment and transpod.
Apply high flow oxygen via mask, observe for deterioration, monitor respirations and LOC. Cardiac monitor and venous access. MAKE BASE CONTACT. Decontaminate if indicated. Administer antidote, if indicated. d Crush ampule d Place in a 4x4 Gauze I (tape inside MasWBVM) d Allow victim to hold antidote and inhale vapor for 60 sec. (ventilate for 60 seconds) d Remove ampule 1 ventilate for 15 sec. d Admin. a new ampule every 2-3 min.
CONTENTS:
Mark I Kit - 30 Amyl Nitrite - 36 (3 boxes of 12)
Contact MAC: 7-323-722-8073 whencacheboxisopenedandused. Inventory documentation includes recording the disaster cache lock number on the F-903 and F-2. (7-03)
Repeat all steps until IV antidote is available in the ED. Treat cardiac dysrhythmias, seizures, and hypotension as indicated per LA Co. Treatment Care Guidelines and Ref # 806.
Revised: 0312004
PAGE 1 OF
Section 3: Apparatus 1 Equipment
H A Z A R D O U S M A T E R I A L S CACHE
v
+ MARK I KIT:
FOR NERVE AGENTS
Indications for use include poisoning with organophosphate nerve agents with at least one sigdsymptom listed: Respiratory distresslmesty SOB Muscle twitchinglseizure Generalized weaknesslparalysis Copious secretions (SLUDGE) Hold auto-injector by the plastic clip with non-dominant hand. The larger auto-injector is on top and held at eye level. With the other handycheck your injection site for any obstacles such as buttons or objects in the pocketsy which may interfere with the injections.
PULL THE SMALL GREEN-TIPPED AUTO-INJECTOR (ATROPINE) OUT OF THE CLIP. REMOVE THE SAFETY CAP (yellow on Atropine; gray on 2PAM-DO NOT TOUCH THE C O L O W D END OF THE INJECTOR after removing the safety cap, since it will inject into the &ngers or hand if any pressure is applied). HOLD IT LIKE A PEN OR PENCIL, BETWEEN THE THUMB AND FIRST TWO FINGERS. POSITION THE GREEN TIP OF THE AUTO-INJECTOR AGAINST THE INJECTION SITE (ANTEROLATERAL THIGH). APPLY FIRM, EVEN PRESSURE (not a jabbing motion) TO THE INJECTOR until it pushes the needle into the thigh or buttock. HOLD THE INJECTOR FIRMLY IN PLACE FOR AT LEAST 10 SECONDS. Carehlly remove and then massage the area. PULL THE BLACK-TIPPED 2-PAM AUTO-INJECTOR OUT OF THE CLIP AND INJECT IN THE SAME MANNER.
Revised: 0 112003
PAGE
2 OF 2
BASE HOSPITAL HAILING AND CHANNEL ASSIGNMENTS
Beverly Cedars-Sinai
(Closed)
1,
# 95
,
-
5E 1B
-
#94 #I7 #64 #81 #42 #92 #28
4E 6B
Glendale Adventist HarborIUCLA Henry Mayo Newhall Holy Cross Huntington Memorial LACIUSC Little Co. of Mary-Torrance Methodist Hosp. of So. Cal. Northridge (NRH) Pomona Valley
I
8C 4D
* NA
7D 5A
4A
6A 5F
2A
2A
4C
6C
2D
#I6 8F 1A 7F
I
#49 #29
# 25
3F
8A
5A 8E 7C
Presbyterian Intercomm.
Q of A IHwd. Pres. (Closed 04/04)
#84
3E
3C
Citrus Valley Robert F. Kennedy (Closed W 0 4 ) St. Francis St. Joseph St. Mary Torrance Memorial UCLA
1
1
#75 # I8 #71 #53 #35 #24 on 7 #79 #59
4F 85 1E 5A 7E 3D
1
1
* NA
35 8E
3A
I1
4E
I
3A
3B
2B
-1.
Revised: 512005
PAGE 1 O F 1
Section 4: Records 1 Documentation
RECORDS AND DOCUMENTATION
THE JOURNAL (F-2) is maintained by each company and is used to record a history of all pertinent
.iformation relative to the daily operation of the command. Entries will appear in a chronological order. Accuracy, clarity, and completeness of entries are essential on all emergency and non-emergency incidents. Incidents where unusual circumstances exist (e.g., crime fatalities, patient refusal of treatment and/or transport, etc.) require a more thorough Journal entry. Members making entries in the Rescue Ambulance Journal shall adhere to the instructions outlined in the Manual of Operation, Volume 5, 917-00.00.
FORMAT
COLOR O F INK: The following entries shall be made in RED ink: + Date (centered at the top of each page and the first available line when a new calendar day begins * Move-up (resulting from an alarm), + Alarm information (emergency and non-emergency). All other entries shall be made in BLUE or BLACK ink. PLATOON CHANGE ENTRIES: + Time, members on duty (include member ID # and assignment), + The status of equipment (cell phone, 800 MHz radio, LAPD ASTRO radio), fuel card, and controlled medications. INCIDENT ENTRIES: + Incident type (e.g., traffic, chest pain, shooting, etc.) and the F-902M sequence number (entered in the margin). + Time of alarm. Underline "Location of Incident." 1 Patient Information: Patient number (in cases of multiple patients), name, age, sex, chief complaint, complete vital signs, and treatment rendered. + Disposition: Transport destination, time complete, time in quarters. Documentation may include ride-a-longs, interns, drills, training sessions, equipment loans and repair, change of rescue staffing during the shift, apparatus placed out of service, injuries, illness, exposure, patient in custody (include LAPD unit number) or any other occurrences incidental to the tour of duty.
PHYSICAL SECURITY OF ALL REPORTS, RECORDS, OR DOCUMENTS CONTAINING PATIENT HEALTH INFORMATION (PHI) SHALL BE SECURED AND NOT LEFT UNATTENDED ON DESKS OR TABLES AT ANY TIME, THIS INCLUDES THE JOURNAL (F-2).
Refer to LAFD Departmental Bulletin No. 03-1 1

THE HAZARDOUS SUBSTANCE EXPOSURE REPORT (F-3) is generated when a member has been or is suspected of being exposed to a hazardous substance. An F-3 is available on the Station Network Staffing System. Instructions are outlined in the Manual of Operation, Volume 5,917-00.00.
STORES REQUISITION (F-80)
1s per Department policy, the F-80 is used to request services or supplies as shown in Volume 4,817 Service and Supplies /Requisition and Delivery. Four copies of the F-80 are initiated by concerned member. Forward part 1 (white), part 2 (canary) and part 3 (pink) to concerned Department subdivision. Retain part 4 (goldenrod) until delivery is received. EXCEPTION: Copies of the F-80 Medical Supply order shall be maintained in the combined file at the fire station for a period of three years.
Revised: 512005
PAGE 1 OF
THE RESCUE EQUIPMENT LOAN SLIP (F-215M) As per Department policy, all LAFD equipment is to be clearly marked. Complete a "Rescue Equipment Loan Slip" (F-215M) in duplicate when equipment is left at a receiving facility. Clearly document on the F-2J5M the following information:
d The incident date and number

dHospital arrival time
d Patient's name (or hospital patient file number) d FD member's name/assignment
A responsible person, from the receiving facility, shall sign and retain a copy of the F-2 15M (loan receipt). The original copy, containing the initiating member's name and assignment clearly printed, is to be retained by the rescue ambulance until the equipment is retrieved. A Journal (F-2) entry is also required.
RECORDS AND DOCUMENTATION
THE EMERGENCY MEDICAL SERVICE REPORT (F-902M) is a subpoenable legal, medical, and billing document that becomes a permanent part of the patient's medical records. First on scene prehospital care providers shall initiate an F-902M for ALL calls dispatched, except "returned by radio." Refer to LAFD, Book 5 (F-902M Instruction Manual). MEDICAL SUPPLIES AND PHARMACEUTICALS procedures are outlined in Departmental Bulletin No. 01-1 3. Refer to DHS, Ref. No. 702.2 and Ref. No. 703 for inventory requirements. O N N E L SHAL.L: Perform a daily inventory check. Document entries of the controlled medications (on hand) on the Controlled Medication Inventory [F-9031 form and in the Journal (F-2), any time there is a change in personnel or controlled medication. Following an incident, all units shall replenish their apparatus inventory of medical supplies and pharmaceuticals immediately upon returning to quarters. Individual paramedic units are provided with a minimum inventory list of EMS supplies to be maintained onboard and intended to supply a resource for an average 24-hour shift. However, to meet specific needs, it may be necessary to increase the established minimums of certain medications andlor supplies. Each fire station shall order EMS supplies and medications (other than controlled medication) on a monthly basis. Attach the monthly use summary to the F-80 cover sheet and forwarded to Supply and Maintenance for processing.
Revised: 512005
PAGE
2 OF 3
Section 4:
Records 1 Documentation
H E CONTROLLED MEDICATION INVENTORY (F-903) form shall be maintained on the apparatus until completed. Completed forms shall be retained on file, at the assigned location of A copy of the com~leted Controlled the ALS unit, for a minimum of THREE YEARS. Medication Inventory form shall be forwarded monthly to the concerned EMS Battalion Office .)
m:
A Journal (F-2) entry will be made of the amount of controlled drugs on hand at shift change;
whenever controlled drugs are received and/or delivered; and any time there is a change of responsible personnel. Notify the EMS Battalion Captain between the hours of 0630-0800 of the need for re-supply of controlled medication and report the current levels of each controlled medication. When a controlled medication is used, provide the original F-902M BLUE to the EMS Battalion Captain in exchange for the replacement medication. When the medication is issued, the paramedic receiving the medication will sign in places: The EMS Battalion Captain's (controlled medication) log and the "Receiving Personnel" column of their individual unit copy of the Controlled Medication Inventory form. (Refer to the Departmental Bulletin No. 0 1- 13.)
THE LOS ANGELES FIRE DEPARTMENT SITUATION REPORT (F-904) is used to facilitate resolution and feedback to inquiries regarding the emergency medical service and/or other Department related critical issues. The data gathered will assist in identifying areas of concern relative to performance, patient care issues, and Department training needs. Refer to LAFD Departmental Bulletin No. 01-06. THE HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA) is a federal legislation for the protection and security of personally identifiable health care information. Members are to take reasonable and prudent measures to secure patients' protected health information (PHI).
The Department has implemented policies and procedures regarding "Notice of Privacy Practices" (NPP). Members shall provide each patient with a written NPP utilized by the LAFD. Acknowledgement of the NPP shall be accomplished by obtaining the patient's signature on the back of the F-902M White copy. Enter NPP given in "Comments" or Transfer of Care" section. If patients are unable to acknowledge receiving the NPP, the NPP shall be left with the patient at the receiving facility. Exception, when the patient is unable, due to altered mental status, age, or in police custody. Document the reason why the patient was unable to sign and that the NPP was provided. (Refer to: LAFD Department Bulletin No. 03-1 1 and Book 5.)
Revised: 512005
PAGE
3 OF 3
CALIOSHA and FEDIOSHA NOTIFICATIONS The senior ranking (EMS) member on the rescue ambulance shall make a CallOSHA notification of serious industrial injuries, illness, or death (other than a traffic accident). If no Department ambulance has responded, the Incident Commander shall make the notification. If the patient is a Los Angeles Fire Department member, the station commander (where the member is regularly assigned) is responsible for making the CallOSHA notification. A serious injury or illness is any injury or illness that may require admission to a hospital for 24 hours or more (for other than observation), treatment for the loss of any body part, or serious permanent disfigurement (i.e., serious bums). The reporting member shall journalize (F-2) the CallOSHA notification including the name of the person notified and the time of notification. Metro/West/South LA (2 13) 576-745 1 (562) 949-7827 (3 10) 5 16-3734 (818) 901-5403
CALIOSHA
DowntownIEast LA Harbor Area San Fernando Valley Area
N x : For Federal Employees contact:
FEDIOSHA
(800) 475-4020 or (619) 557-2909
Additionally, AS SOON AS POSSIBLE,

Contact the District Attorney's Office for all incidents involving: Industrial Related Death or Near Death
District Attorney
Command Post telephone number
( 2 13) 974-3607
The following information will be required for all notifications: Incident Date and Time Patient's Name and Age Patient's Home Address Patient's Occupation Name of Employer Employer's Address On-site Supervisor's Name and Telephone Number Incident Address Patient Destination (Receiving facility) Extent of Injury Description of Incident
PAGE 1 OF
Revised: 0212003
LEVEL I
Contact limited to merely being in the presence of a person suspected of having a communicable disease.
LEVEL I1
Contamination of clothing or equipment by blood and/or body fluids. Exposure of skidmucus or conjunctival membranes to blood and/or body fluids (e.g., vomitus, urine, feces). This category includes ingestion of "possible" contaminated food, needle puncture, and human bites. (Refer to LAFD, Training Bulletin No. 82.)
LEVEL I11
For known or suspected exposure to an infectious/cornrnunicabledisease, blood and/or body fluids, or if the member sustains a contaminated needle wound, do the following:
1 1. 1 1 2. 1
3.
4.
5.
Immediately cleanse the affected area. Notify your Station Commander.

-
1 1
Notify the appropriate EMS Battalion Captain of all "Level 111" exposures. On the F-902M, check "Inquiry Requested" box and document in the Comments section. Complete and forward an F-420; complete an F-225 or F-166A; and D WC Form 1 for all "Level I1 and 111" exposures. Ensure a detailed entry in the Journal (F-2) and the member's Personal Record Book. Members shall not seek or receive "first care" until consultation and direction has been received from the Medical Liaison Unit and/or the EMS Battalion Captain.
1 6. 1
COMMUNICABLE DISEASE EXPOSURE AND NOTIFICATION REPORT (F-420) The F-420 shall be carried on all LAFD apparatus and shall be completed by the concerned member who may have been exposed to a "Reportable Communicable Disease" and/or received a contaminated needle wound. The F-420 original copy is given to the hospital. Reportable Communicable Diseases Include:
+ AIDS + Hepatitis + Meningitis + Syphilis + Tuberculosis

Revised: 512005
PAGE 1 OF
Department equipment which has been contaminated with blood or other body fluids, shall be decontaminated by members wearing disposable rubber protective gloves as follows:
Rescue equipment such as traction splints, backboards, KED boards, blood pressure cuffs, bag-valve-mask device, airway management instruments, etc., shall be washed with a disinfectant-detergent solution and hot water then air dried. Delicate electronic equipment such as scope/defibrillators,radios, etc., shall be wiped down with a 1:10 bleachlwater solution (1 part bleach to 10 parts of water) as soon as possible post incident. The rescue ambulance patient area should be scrubbed with a 1:10 bleachlwater solution, rinsed with clear water and air dried.
Needles are to be handled with extreme care. The Department supplies sharp containers that are to be used for all dirty needle disposal. If self-covering IV catheters are not being used, the contaminated needles shall be recapped for safety of personnel. Place the cap on a flat surface and replace the needle in the cap using a "one-handed method."
Note: Do not stick needles in R A seat cushions.
Revised: 1212001
PAGE
2 OF 2
Section 4: Records I Documentation
SUSPECTED CHILD ABUSE I NEGLECT REPORTING GUIDELINES

/'
The primary purpose of the Department of Justice Suspected Child Abuse Report form SS 8572 (DHS, Ref. No 822.2) is to make all agencies aware of possible abuselneglect. In order to facilitate this process in Los Angeles County, it is recommended that a prompt verbal report be made to both the Department of Children and Family Services (DCFS) and local law edorcement. However if the child is in imminent danger, local law enforcement should be notified immediately. To make a verbal report to DCFS, call the
CHILD ABUSE HOTLINE at: (800) 540- 4000

This should be done as soon as possible. It is recommended that the Child Abuse Report form be completed prior to making verbal notification. The Suspected Child Abuse1 Neglect report is to be completed according to the instructions on the back of the form
DCFS 3075 Wilshire Blvd. Los Angeles, California 90010
SUSPECTEDELDERAND DEPENDENTADULTABUSE REPORTING GUIDELINES
Paramedics and EMTs, as health care practitioners, are mandated reporters and have a legal obligation to report known or suspected elder and dependent adult abuse.
An elder is a person 65 years of age or older. A dependent adult is a person 18-64.yearsold, who
have physical or mental limitations that restrict their ability to protect their own rights or carry out normal activities. DEPARTMENT MEMBERS SHALL MAKE A REPORT WHENEVER: + The member observes or has knowledge of an incident that reasonably appears to be abuse, or + The member is told of an incident by the victim, or + The member reasonably suspects abuse. Mandated reports of physical abuse, sexual abuse, isolation, abandonment, financial abuse, neglect, and self-neglect are to be made immediately or as soon as practically possible by telephone. The follow-up written report must be SENT WITHIN TWO WORKING DAYS to the agency to which the telephone report was made. Voluntary reports of other types of abuse, such as mental abuse or abduction, may be made either !bytelephone or by means of the written report mailed or faxed to the appropriate agency.
Revised: 0912003
PAGE 1 OF
SUSPECTEDELDERAND DEPENDENTADULTABUSE REPORTING GUIDELINES
When the abuse or neglect is suspected to have occurred in a LONG-TERM CARE FACILITY report either to the local law enforcement agency or to:
'\
Long Term Care Ombudsman 1527 Fourth Street, Suite 250 Santa Monica, CA 90401 Telephone: (800) 334-WISE (8001 334-9473) Fax: (3 10) 395-4090 Afler hours telephone: (800) 23 1-4024 (State Crisis Line)
LONG-TERM CARE FACILITY : Includes, but is not limited to, the following facilities: 1. Any long-term health care facility, such as a nursing facility, a skilled nursing facility, a congregate living health facility, a licensed respite care facility, or an intermediate care facility, including habilitative and nursing intermediate care facilities for the developmentally disabled. 2. A community care facility, such as an adult day care facility, an adult day support center, an adult residential facility, or a social rehabilitation facility, whether licensed or unlicensed. 3. A swing bed in an acute care facility, or any extended care facility* A licensed residential care facility for the elderly. 4. When abuse, neglect, or self-neglect is suspected to have occurred ANYWHERE ELSE, report either to the local law enforcement agency or to:
,
Los Angeles County Adult Protective Services Centralized Intake Unit 3333 Wilshire Blvd., Suite 400 Los Angeles, CA 90010 Telephone: (888) 202-4-CIU (888) 202-4248 Fax: (213) 738-6485 Afler hours telephone: (877) 4-R-SENIORS (877) 477-3646
TELEPHONE REPORT: Reports are to include as much of the following information, as possible:
1. The name, address, telephone number, and occupation of the person making the report. 2. The name, address, and age of the elder or dependent adult.
3. The names and addresses of family members or any other person responsible for the elder or dependent adult's care.
4. The nature and extent of the elder or dependent adult's condition.
5. The date and place of the abuse incident.
6. Any other information requested by the receiving agency, including information that led the reporter to suspect elder or dependent adult abuse. 7. Information about the suspected perpetrator.
Revised: 09D003
PAGE
20 ~ 3
S U S P E C T E D E L D E R AND D E P E N D E N T A D U L T A B U S E REPORTING GUIDELINES

A
#i
WRITTEN REPORT: The Report of Suspected Dependent AdultElder Abuse (Ref. No. 829.1) must be completed and submitted to the agency initially contacted. Upon completion, immediately forward the report to the involved EMS Battalion Captain. The EMS Battalion Captain shall review and Fax the report to the appropriate agency.
THIS PROCESS SlULL NOT EXCEED TWO (2) . . WORKING DAYS (48 HOURS) OF THE TELEPHONE REPORK
WITHIN 48 HOURS
PARAMEDICS AND EMTS ARE MANDATED REPORTERS. I F YOU SUSPECT ABUSE, NEGLECT, OR SELF-MGLECT, YOU AFU3 REQUIRED BY STATE LAW TO WPORT IT. RECORD YOUR OBSERVATIONS OF ELDER D U S E AS YOU DO FOR CHILD ABUSE.
LOS ANGELES COUNTY ELDER ABUSE HOTLINE:
(877) 4- R-SENIORS (877) 477-3646
Shortage of food Excessive trash Utilities are turned off
Unkempt, odorous Passive or afraid
Unemployed Substance abuser
1 Bruises, scratches, cuts H o w reeks of urinelfoul odors 1 Confhed

Insect and vermin infestation Broken whdowslcode vioIations, etc.
1 Calls 911 fiequently

I
1 Mental disorder 1 Uncooperative

Speaks for dependent person
I
1 1
Tells you there is neglect or abuse Aggressive or controlling
N P E S OF ABUSE:
Physical Sexual
Financial Abandonment
Isolation Abduction
Neglect
others
Psychological I
Neglect by self
ADULT PROTECTIVE SERVICES (APS) Social Workers investigate reports of suspected abuse and neglect (24-hours a day in life-threatening situations).
YOUR OBSERVATIONS HELP WITH THE INVESTIGATION.
ELDERS: 65 years of age or older DEPENDENT ADULTS: 18-64 year olds who have physical or mental limitations that restrict their ability to protect their o m rights or carry out normal activities.
Revised: 912003
PAGE
3 OF 3
COMMUNICATION F A I L U R E P R O T O C O L
Communication Failure Protocols (DHS, Ref. No. 810) are followed when paramedics are unable to establish andor maintain base hospital communications and a delay in treatment may jeopardize the life of a patient. In those cases the following procedures will be adhered to: Perform a thorough patient assessment and record all findings on the F-902M. Initiate the appropriate treatment protocol(s) for the patient's presenting signs1symptoms as per the EMT-P Communication Failure Protocol Quick Reference. Transport to a general acute care hospital in accordance with LA County Policies. Transport as quickly as possible consistent with optimal patient care (may occur at any point in the standing orders). Make vigorous attempts to establisldmaintain voice contact with physician or MICN while en route to the receiving hospital. IMMEDIATELY make a VERBAL REPORT to the on-duty emergency room physician or MICN at the assigned base hospital. Complete the ALS Communication Failure Report Form as described in DHS, Ref. No. 8 10. Non compliance with this policy may be construed as hctioning outside the supervision (scope) of medical control under the Health and Sdety Code l798.2OO(c)(lO).
WRITTEN REPORT : Within 24 hours of the incident, involved paramedics shall complete Section A and forward the form to the Base Hospital Medical Director at the assigned base hospital.
WITHIN
y, ,
>
24 HOURS
Revised: 912003
PAGE 1 OF 1
COMMUNICATION F A I L U R E P R O T O C O L
/ /
Communication Failure Protocols (DHS, Ref. No. 810) are followed when paramedics are unable to establish andor maintain base hospital communications and a delay in treatment may jeopardize the life of a patient. In those cases the following procedures will be adhered to: 1. Pedorm a thorough patient assessment and record all findings on the F-902M.
2. Initiate the appropriate treatment protocol(s) for the patient's presenting signs/symptoms as per the EMT-P Communication Failure Protocol Quick Reference.
3. Transport to a general acute care hospital in accordance with LA County Policies.
4. Transport as quickly as possible consistent with optimal patient care (may occur at any point in the standing orders).
5. Make vigorous attempts to establishlmaintain voice contact with physician or MICN while en route to the receiving hospital.
6. IMMEDIATELY make a VERBAL REPORT to the on-duty emergency room physician or MICN at the assigned base hospital.
7. Complete the ALS Communication Failure Report Form as described in DHS, Ref. No. 8 10.
8. Non compliance with this policy may be construed as hctioning outside the supervision (scope) of medical control under the Health and Safety Code 1798.200(~)(10).
\
-4
WRITTEN REPORT : Within 24 hours of the incident, involved paramedics shall complete Section A and forward the form to the Base Hospital Medical Director at the assigned base hospital.
WITHIN
24 HOURS
Revised: I212001
PAGE
1 OF 1
, Mnemonics (memoryjoggers) are effective tools used to assist EMS personnel in conducting
more thorough assessments. The following are a few examples to assist with patient assessments.
SECONDARY (FOCUSED) 'SURVEY (SAMPLE / 3 "T's") S A M P L E T T T -Signs/Symptoms -Allergies -Medications -Past medical history -Last oral intake. -Event preceding. -Tags (Medical) -Tracks -Trauma
1
D C A P P
BURN INJURY (DCAPP-BTLS) -Deformities -Contusions -Abrasions -Penetration -Paradoxical movement
1
E R M
NEUROLOGICAL
I 1
LEVEL OF RESPONSIVENESS (AVPU)
-Depth of coma -Eyes -Respiratory status -Motor response
A V P U
-Alert -Responds to Verbal stimulus -Responds to Painful stimulus -Unresponsive
INJURED EXTREMITY (Distal to Injury) (PMS)
TO ELICIT PERSONAL HISTORY
W H A M
-Weight -History of medical problem -Age, allergies -Under D's care

-
BONY AREA EXAM
SIGNS OF A TENSION PNEUMOTHORAX (PUNT) -Progressive Dyspnea -Unilateral Breath Sounds -Neck Vein Distension -Tracheal Deviation
P U N T
Revised: 1212001
PAGE 1 OF
CAUSES OF ASYSTOLE (4-H Police Department) H H H H P D -Hypoxia -Hyperkalemia -Hypokalemia -Hypotherrnia -Pre-existing Acidosis -Drug Overdose
ET DRUG ADMINISTRATION
NARCOTICS INHIBITED BY NARCAN Many Doctors Practice Tender Loving Care Many Hours Daily
DRUG CHECK PRIOR TO ADMINISTRATION D I C C E (DICCE) -Drug/Dose -1ntegritylIndications -Clarity -Concentration/Contraindications -Expiration date
1
1
M A T C H E D POSSIBLE CAUSES OF PEA (MATCH (X4) ED) -Myocardial Infarction (massive acute) -Acidosis -Tension Pneurnothorax -Cardiac Tamponade -Hypoxia, Hypovolemia, Hyperkalemia, Hypotherrnia -Pulmonary Embolus -Drug Overdose
ABDOMINALPAIN (DR. GERM) D R G E R M -Distention -Rigidity -Guarding -Ecchymosis -Referred Pain -Masses
ASSESSMENT TOOL (SOAP)
COMMON CAUSES OF PEDIATRIC SEIZURES
NEUROVASCULAR COMPROMISE
("5 P's")
F H E
L P
Revised: 912001
-Fever -HeadTrauma -Epilepsy (medically diagnosed) -Low blood sugar1 chemical disturbances -Poison/overdose
Pain Pulse Paresthesia Paralysis Pallor

2 OF 2
Where, what's causing it? Is there a distal pulse in the injured extremity? Any abnormal sensation at the site? Indicates peripheral nerve damage or circulatory impairment. Check color, temperature, and capillary refill.
PAGE
Abdomen Abortion
ABD AB ABR AJ R AVR ACC AIDS ALTE
Anterior Apical Pulse Appointment Approximately Arterial Blood Gases Artery As Needed As Soon as Possible Aspirin Assault Assaulted with a Deadly Weapon Asystole At Once Atrial Fibrillation Atrial Flutter
1 ANT
-~
Abrasion
Accelerated Junctional Rhythm Accelerated Ventricular Rhythm Accident Acquired Immune Deficiency Syndrome Acute Life Threatening Event Acute Myocardial Infarction
I APPRO:
ASAP
1
1
ASA AST ADW ASY STAT AF I AFL
Adult Respiratory Distress Syndrome ARDS Advanced Health Care Directive Advanced Life Support Advised After Care Instructions After I Past I Post Against Medical Advice Agonal Airway 1 Breathing I Circulation Alcohol On Breath
-
AHCD ALS ADV ACI
AMA AGO ABC AOB
Atrioventricular Attempted Suicide Auscultation Automated External Defibrillator Axillary
kBBD BOW BVM BHMD
Alert & Oriented times 3 Parameters (Purpose, Time, Place) Allergies Altered Altered Level of Consciousness Ambulance / Ambulatory Amount Ampule Antecu bital ALG ALT ALOC AMB AMT AMP
Backboard Bag of Waters Bag-Valve-Mask Base Hospital Medical Director Basic Life Support Before
BLS
Revised: 512005
PAGE 1 OF 9
Section 4: Records / Documentation
Cervical Vertebrae
---.-
C-1, C-2, etc.
Chest Pain
Chief Complaint Chronic Obstructive Pulmonary Disease Chronic Renal Failure Circulation, Sensation, Movement Clean and Dress Clear Communication Failure Protocol Complains Of Complete Blood Count Complete Heart Block Congestive Heart Failure Contact Not Attempted CBC CHB CHF CNA CLR CFP COPD CRF CSM
Carbon Dioxide
Contagious Disease Contusion Coronary Artery Bypass Surgery CONT CABS CAD
Cardioversion Catheter Centigrade / Celsius Central Nervous System Cerebrospinal Fluid Cerebrovascular Accident Certified Nurse Assistant Cervical Spine
CAR CATH C CNS CSF CVA CNA C-SP
Coronary Artery Disease Coronary Care Unit Corrected To Cubic Centimeter Date of Birth Dead on Arrival Decrease Defibrillation
ccu
C/T
DOB DOA DECR DEF
Revised: 512005
ABBREVIATIONS
Delirium Tremens
Diabetic Ketoacidosis Diagnosis
-Dextrose 5 Percent in Water Esophageal Gastric Tube Airway EGTA EOA Diabetes Mellitus Esophageal Obturator Airway Estimated EST DX Estimated Blood Loss Dilation and Curettage Discontinue Distal
D&C
DT9s
Equal and Reactive
E&R
Estimated Time of Arrival * ,
Ethyl Alcohol Evaluation
ETOH EVAL
DIST DNR
Do-Not-Resuscitate
Examination
EXAM
Drop
gtt
Expected Date of Confinement
EDC
Dry Sterile Dressing Duodenal Ulcer
DSD
Expected Date of Delivery Expiratory
EDD
EXP EXT
Dyspnea on Exertion Each, Every
External
Electrocardiogram
1 ECG (EKG]
EEG ED
Eyes, Ears, Nose, and Throat Fahrenheit
EENT F
Electroencephalogram
Family History
FH
Emergency Department
Fetal Heart Tones
FHT
Emergency Department Approved for Pediatrics
EDAP EMS
Fever of Unknown Origin
FUO
Emergency Medical Service (System)
Fixed and Dilated Fluid
F&D
Emergency Medical TechnicianAdvanced Airway
Emergency Medical Technician
Emergency Medical Technician-Paramedic EMT-P Emergency Room
Follow Up
Foreign Body
FB
Esophageal Tracheal Combitube
Four Times a Day
QID FX
Endotracheal Tube
ET
Fracture
Revised: 512005
PAGE
3 OF 9
ABBREVIATIONS
Frequent Gallbladder Gastroenteritis Gastrointestinal Genitourinary Glasgow Coma Scale Grain Gram Gravida Gunshot Wound Has Been Drinking Headache
~"-"
FREQ GB
Hypertension Hyperventilation
1 HTN
1 GE
GCS
I
IDLH INCR
ldioventricular Rhythm Immediate Danger to Life & Health Increase Inhaled Injury Inspiration Insulin Dependent Diabetes
- - -
I 1
IN
INJ INSP IDD
1 1
GSW HBD
Intake and Output Intensive Care Unit International Unit Intramuscular ICU IU IM IUP IV IVPB IVP INVOL
Heart Block Heart Block- (1st 1 2nd 1 3rd ) Degree Heart Rate I Hour Heart Sounds Height
-
Intrauterine Pregnancy Intravenous

I
HR
Intravenous Piggyback
1
HEM0
Intravenous Push Involuntary Irrigation Joint
Hemorrhage History History of Present Illness Hospital Hospital Emergency Administrative Radio Hospital Emergency Response Team Human Immunodeficiency Virus
HX
JT JVD JR KVO kg KO
HPI
1 HOSP
HEAR
I
1
Jugular Vein Distention Junctional Rhythm Keep Vein Open Kilogram
HERT
1 HIV
Knock Out
-- -
Laboratory
LAB
Revised: 512005
PAGE 4 OF
Section 4: Records / Documentation
--
Laceration Large Last Normal Menstrual Period

I
Middle Midline LNMP LAT Military Anti-Shock Trousers Milliequivalent Milligram Milliliter Minimal Blood Loss Mobile lntensive Care Nurse Mobile lntensive Care Unit Moderate Month Morning Morphine Sulfate /Multiple Sclerosis LIMIN Most Accessible Receiving (facility) MAR Motor Vehicle Accident Motorcycie Accident MVA m!3 mL MBL MICN MICU MOD MO AM MAST
Lateral Left / Liter Left Bundle Branch Block Left Lower Extremity Left Lower Quadrant Left Upper Extremity Left Upper Quadrant Level / Loss of Consciousness Licensed Vocational Nurse Liquid Liters per Minute Long Backboard Lumbar Spine Lumbar Vertebrae Meconium Medical Medical Doctor Medications Mental Retardation
----
@
LBBB
1 LLE
LLQ
1 LUE
LUQ LOC
'
L-I , L-2, etc.
Moves All Extremities Multifocal Multiple Myocardial Infarction Nasal Cannula Nasogastric Tube
Mentally Disordered Person Microdrop Midclavicular Line
MDP MCIGlT MCL
Nasopharyngeal Nausea 1 Vomiting 1 Diarrhea Negative
Revised: 512005
PAGE 5 OF 9
Neonatal Intensive Care Unit Newborn Nitroglycerine No Apparent Distress No Known Allergies Non-breathing,Unconscious, Pulseless, Unresponsive Normal Normal Saline Normal Sinus Rhythm Normal Spontaneous Vaginal Delivery Not Applicable INot Available Nothing by Mouth Notice of Privacy Practices Object IObjective Obstetrical IGynecological Occasional Organic Brain Syndrome Oropharyngeal Ounce Overdose Oxygen Pacemaker Rhythm Palpation Para IPulse Afternoon 1 Evening Paramedic I Paroxysmal Nocturnal Dyspnea
NICU
Paroxysmal Supraventricular Tachycardia Partial Pressure of Carbon Dioxide Partial Pressure of Oxygen Past Medical History Patient 1 Physical Therapy
PSVT
1 NB
PO2 PMH
Nupu
Pedal Edema Pediatric
PED ED PED PMC PTC PID
1 NS 1 NSR
I
Pediatric Medical Center Pediatric Trauma Center Pelvic Inflammatory Disease Penicillin
NIA
PCN PERC PR PPE POSS POST POST OP
1 NPO
Percussion Per Rectal Personal Protective Equipment Possible
1 1
NPP
1 OBJ
OBIGYN OCC OBS OP OZ OD 02 PMR
Posterior Postoperative Postpartum Prehospital Care Coordinator Premature Atrial Contraction Premature Junctional Contraction Premature Ventricular Contraction Prenatal Care Prior To Arrival Private Private Medical Doctor
PCC PAC PJC PVC PNC PTA PVT PMD
PALP P PM PND
Revised: 512005
ABBREVIATIONS
PRO PROX PAD PUL ED Sacral Spine Saline Lock I Sublingual seizure
. . . . . -
Protocol Proximal
S-S P SL
-
Public Access Defibrillator Pulmonary Edema Pulmonary Embolus Pulseless Electrical Activity Pulses 1 Movement 1 Sensation Pupils Equal and Reactive to Light Radial Range of Motion Red Blood Cell Refused Medical Assistance Registered Nurse Resident Of 1 Rule Out Respiration Respiration Rate Returned by Radio Revised Trauma Score Rheumatic Heart Disease Right Right Bundle Branch Block Right Lower Extremity Right Lower Quadrant Right Upper Extremity Right Upper Quadrant
-ffD
SBB
Sexually Transmitted Disease Short Backboard
PEA PMS PERL RAD ROM RBC RMA
Shortness of Breath
SOB
Sinus Arrhythmia Sinus Bradycardia Sinus Tachycardia small Small Bowel Obstruction solution
-+
SB
SA
SBO
SOL
wo
RESP
Specialty Center Standing Field Treatment Protocol Stab Wound
RxR RTS RHD
Subcutaneous Subjective Substernal Chest Pain Sudden Infant Death Syndrome
SQ
SUBJ
SSCP SIDS SUPP
RBBB RLE RLQ RUE RUQ
Suppository
Revised: 512005
PAGE 7 OF
Section 4: Records IDocumentation
Supraventricular Tachycardia Symptom Syrup Tablet Tachycardia Temperature Tender Loving Care Tetanus Toxoid Thoracic Spine Thoracic Vertebrae Three Times a Day Times / By To Keep Open (Total) Body Surface Area Traffic Accident Traffic Collision Transient Ischemic Attack Transport Treatment Tuberculosis Twice a Day Tylenol Unable to Locate BID TYL UTL TIA TRANS T-SP T-1. T-2. etc. TID SYR TAB TACH T TLC SVT Unconscious Unifocal Upon Our Arrival Upper Gastrointestinal Upper Respiratory Infection Urinary Tract Infection Venereal Disease Ventricular Fibrillation Ventricular Tachycardia Verbal Order Vital Signs / Versus Volume Water Watt-Second Weak Weight Well Developed / Well Nourished White Blood Cell Wide Open With Within Normal Limits Without YearIOld Female YearIOld Male WNL WDIWN WBC VOL H20 UOA UGI URI UTI UNC
x
TKO (T) BSA
---
Revised: 512005
.
0
Year I Old Male Decrease I Negative 1 Minus Equals
1 -
Female
Greater Than
Increase I Positive I Plus
c
No Change Number Percent
Less Than
Secondary To
Revised: 512005
PAGE
9 OF 9
Section 4: Records & Documentation
BIBLIOGRAPHY
M-S Unit Inventory 'advance Health Care Directives (AHCD) UTE (Apparent Life Threatening Event) 'aMA/Patient Refusal of Treatment or Transport 'application of Patient Restraints 'aspirin Administration to Chest Pain Patients 'assessment of Altered Level of Consciousness Glasqow Coma Scale (GCS) Revised Trauma Score (RTS) ksessment Unit Inventow apparatus Maintenance 'automated External Defibrillators Base Hospital ContactlTransportation Criteria Body Armor Vests Bomb Scene Incidents Burn Patient Destination CAUOSHA and FEDIOSHA Notifications
1
1
LAFD Book 33 1 EMS UPDATE LAFD Book 33 LAFD Book 33 Dept. Bulletin LAFD Book 33 Dept. Bulletin LAFD Book 33 LAFD Book 33 EMS UPDATE LAFD Book 33 LAFD Book 8 1 Training Bulletin Dept. Bulletin LAFD Book 33 Training Bulletin Training Bulletin LAFD Book 33 Dept. Bulletin MOP, Vol. 1 Dept. Bulletin
I
Ref. No. 702
2003
Ref. No. 808.1 Ref. No. 834 No. 01-10 Ref. No. 838 No. 99-20 Ref. No. 809 Ref. No. 809
1999
Module 4 No. 64
1 Ref. No. 703

No.98-14, 99-11, 9 9 1 4 Ref. No. 808 No. 81 No. 75 Ref. No. 512 No. 99-09 2/1-4234 & 2/1-56.01 No. 96.29
No. 98-17 Ref. No. 836.2 Ref. No. 836 Ref. No. 836.1 Ref. No. 836.3 No. 82 Ref. No. 810 No. 98-20 Ref. No. 518 Ref. No. 814 No. 100
Cellular Telephone Procedures Communicable Disease Decontamination Communicable Disease Exposure and Notification (F-420) Source Patient HIV Status Source Patient HIV Status Flowchart Petition for Order to Test Blood (Accused) Infectious Disease Protocols Communication Failure Protocol Conditionally Available (CAV) & Non-Available (NAV) Decompression EmergenciesIPatientDestination DeterminationIPronouncement of Death in the Field Disposing of Medical Waste EMS Report Short Form for Multi Casualty Incidents (MCI) EMS UPDATES 1996-1997,1999,2000,2001,2002,2003 EMS Safety Eye Shield and Face Masks EMT-1 Scope of Practice
1
I
1
I
Dept. Bulletin 1 LAFD Book 75 LAFD Book 33 LAFD Book 33 LAFD Book 33 LAFD Book 33 Training Bulletin LAFD Book 33 Dept. Bulletin LAFD Book 33 LAFD Book 33 Training Bulletin MOP, Vol. 1 1 Dept. Bulletin
I
211-84.60 No. 03-19

No. 92-7 Ref. No. 802
Dept. Bulletin LAFD Book 33
Revised: 512005
PAGE 1 OF
BIBLIOGRAPHY
Eaui~ment Retrieval Procedure Firelighter Burn Injuries Health Insurance Portability and Accountability Act (HIPAA) Honoring Prehospital Do-Not-Resuscitate (DNR) Orders Hospital Directory Hospitals Requesting Diversion of ALS Units (Guidelines) Hospital Status Information via Mobile Data Terminals (MDTs) Infectious Disease Protocols LAFD EMT Re-certification Training Course Lifepak 12 Cardiac MonitorIDelibrillatorUse Management of Multiple Victim Incidents Medical Guidelines (DHS) Medical Supplies and Pharmaceuticals Minimum Equipment Used on Incidents Multi-Casualty Incident Procedures Multi-Casualty Medical Supply Cache Notice of Privacy Practices (NPP) Paramedic Emergency Care, Third Edition, Brady, 1997 Paramedic Training Institute, January 1997 Prehospital Emergency Care, 6th Edition, Brady, 2000 Patient Destination Guidelines Decompression Emergencies Sexual Assault Patient Destination Pediatric Patient Destination Perinatal Patient Destination Patient Resolution Guide (PRG) Patient Transportation Policy Police Custody (Patient Care Policy for Patients in Custody) Reporting of AbuseINeglect-Child, Elder, Dependent Adult Rescue Ambulance Preventative Maintenance Rescue Equipment Loan Slip (F-215M) Safety Precautions While Using RA Gurneys Service Areas Situation Report (F-904) Spinal Immobilization START (Simple Triage and Rapid Treatment) Suspected Child Abuse Reporting Guidelines Suspected Elder and Dependent Adult Abuse Reportinq
Revised: 512005
PAGE
1 1
LAFD Book 33 Dept. Bulletin Dept. Bulletin LAFD Book 33 LAFD Book 33 LAFD Book 33 Dept. Bulletin Training Bulletin Dept. Bulletin LAFD Book 33 LAFD Book 32 Dept. Bulletin LAFD Book 63 LAFD Book 70 Dept. Bulletin Dept. Bulletin Dept. Bulletin Syllabus 1
I Ref. No. 708
I No. 99-09 1 No. 03-1 1

No. 98-21 No. 82
Ref. No. 815 Ref. No. 501 Ref. No. 503
No. 0506 Ref. No. 519 No. 04-08 Pg. 54-55 No. 89-8 No. 04-03 No. 03-1 1
Syllabus 6
'
LAFD Book 33 Ref. No. 502 LAFD Book 33 Ref. No. 518 Ref. No. 508 LAFD Book 33 Ref. No. 510 LAFD Book 33 LAFD Book 33 Ref. No. 51 1 Training Bulletin No. 18 1 Dept. Bulletin 1, No. 04-22 1 Dept. Bulletin 1, No. 04-17 No. 92-5 Dept. Bulletin LAFD Book 33 No. 822,829 MOP, Vol. 5 , 917-00.00 (1-89) MOP, Vol. 5 Dept. Bulletin No. 96-1 1 1 Dept. Bulletin 1 No. 94-21 1 Dept. Bulletin 1 No. 01-06 Training Bulletin No. 87 LAFD Book 70 Ref. No. 822 LAFD Book 33 Ref. No. 829 LAFD Book 33
I I
1
I
!
I I
2 OF 3
BIBLIOGRAPHY
Towing Apparatus Procedures Trauma Catchment Areas Trauma Hospital Temp. ClosureIDiversion of Trauma Patients Trauma Triage Transporting Patients in Custody Trans. Pre-paid Health Plan Members to Kaiser Facilities Treatment 1 Transport of Minors Trial Program-Emergency Medical Service Areas for California & Good Samaritan Hospitals Trial Program, Hospital Transportation Service Areas V-Vac Hand Powered Suction Unit Variable Staffed BLS Ambulance Program
1
1
I
MOP, Vol. 4 p ~ / 3 - 4 4 . 0 1 LAFD Book 33 LAFD Book 33 LAFD Book 33
1
1
I
I Ref. No. 504

I
Ref. No. 505 Ref. No. 506 Ref. No. 838
LAFD Book 33 Dept. Bulletin Dept. Bulletin LAFD Book 33
1
I
No. 93-12 No. 03-12 Ref. No. 832 No. 92-3 No. 90-17
Dept,
Dept. Bulletin
1 1
I
Training Bulletin Dept. Bulletin
1 1
I
No. 72 No. 04-22
Revised: 512005
PAGE 3 OF 3
Los Angeles Fire Department
EMS FIELD MANUAL

Book 35
Record of Revisions
Keep your manual current. After receiving and filing additional or revised pages, initial and date the appropriate columns following the change number. No blanks should appear between initialed blocks. If you have failed to record a revision notice or have not received one, notify the Quality Improvement Section at (213) 485-71 53.
CHANGE NOTICE #
INITIAL
DATE
CHANGE NOTICE #
INITIAL
DATE
*** Revisions incorporated into manual
PAGE I OF 2
Revised: 512005

LAFD Field Manual

Загружено:

Сведения о документе

Исходное описание:

Авторское право

Доступные форматы

Поделиться этим документом

Поделиться или встроить документ

Параметры публикации

Этот документ был вам полезен?

Это неприемлемый материал?

Авторское право:

Доступные форматы

LAFD Field Manual

Загружено:

Авторское право:

Доступные форматы

Preface

contact the Quality Improvement Section at (2 13) 485-7 153.

EMS Field Manual (Book 35)

1.0 1. 1 1.2 1. 2a 1.3 1. 3a 1.4 1.4a 1.4b 1.5 1. 6 1.7 1. 7a 1. 7b

EMS Field Manual (Book 35)

LA County Trauma Center Maps

EMS Field ~ a k a (Book l 35)

Section 1: Field Procedures 1 Protocols

LAFD PATIENT ASSESSMENT GUIDELINES

+ Color + Temperature + Moisture

CHIEF COMPLAINT (SignsISymptoms)

+ What you see!

Objective Observation Subjective Findings (What they say!)

COMPLETE BODY CHECK

HEAD NECK CHEST

BREATHSOUNDS ABDOMENIPELVIS EXTREMITIES (UpperILower)

DEFORMITY CONTUSION ABRASION PUNCTURE1 PENETRATING

BURNS TENDERNESS LACERATIONS SWELLING

PULSES MOTOR SENSORY

Section I: Field Procedures 1 Protocols

LAFD PATIENT ASSESSMENT GUIDELINES

M Medications P Past History L Last AteIDrank E Events Preceding

AIRWAY (OIP, Mask) BREATHING (Position IBVM 102)

SPINAL PRECAUTION GLUCOSE OB ASSISTANCE BANDAGING 1 SPLINTING

Position Patient) CIRCULATION (Direct Pressure I

Motor Response Verbal Response

REVISED TRAUMA SCORE (RTS) ,. ... . (Uoded Values) SBP + RR + GCS

Section 1: Field Procedures 1 Protocols

SIMPLE TRIAGE and RAPID TREATMENT

Simple Triage and Rapid Treatment

Section 1: Field Procedures 1 Protocols

ACUTE LIFE-THREATENING EVENT (ALTE)

The evaluation and history taking for ALTE patientsconsists of:

* Age 1-3 years: Base Contact andor Transport is required.

Section 1: Field Procedures 1 Protocols

BROSELOW PEDIATRIC EMERGENCY TAPE

Section 1: Field Procedures 1 Protocols

+ Day of the week I year I time of day

+ Where helshe lives I where they are now

GLASGOW COMA SCALE (GCS)

21HLD (12 months to 14 years)

Section 1: Field Procedures 1 Protocols

REVISED TRAUMA SCORE

THREE assessment elements comprise the RTS:

The "coded value" (sum) of the: SBP + RR + GCS =

Section 1: Field Procedures 1 Protocols

PATIENT REFUSAL of TREATMENT 1 TRANSPORTATION

Section 1: Field Procedures 1 Protocols

CHILD / ELDER / DEPENDENT ADULT ABUSE

punishment, willful cruelty, unjustifiable punishment, or sexual assault.

3. The member in charge of patient care shall

Patients Determined to be Dead

* Assess pupil response with a penlight or flashlight

Medical Patients in Cardiopulmonary Arrest

* Treated in the field long enough for possible resuscitation to occur.

Section 1: Field Procedures 1 Protocols

Crime Scenes I Accidental Deaths I Suspected Suicides

Procedures Following Determination of Death

Documentation for Reports

+ The criteria used to determine death.

(Listed in Section 1.7a.)

Section 1: Field Procedures 1 Protocols

PREHOSPITAL DO-NOT-RESUSCITATE (DNR) ORDERS